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General NPI Number Information
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NPI Number | 1023999414
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Entity Type | Individual
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Provider Name | JOSE JUAN RUSSE RUSSE MD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 70 CALLE SANTA CRUZ
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City | BAYAMON
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State | PR
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Zip | 00961-7052
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Country | US
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Telephone | 787-620-4747
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Fax |
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Provider Business Mailing Address
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Address Line | HC 67 BOX 15090
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City | BAYAMON
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State | PR
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Zip | 00956-9510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2564-PA
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 17631-I
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License Number State | PR
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