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General NPI Number Information
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NPI Number | 1043381080
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Entity Type | Organization
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Legal Business Name | JERRDAM MEDICAL, CSP
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CALLE 21 U 3#5 LAS LOMAS
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City | RIO PIEDRAS
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-775-2545
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Fax |
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Provider Business Mailing Address
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Address Line | PMB 409 PO BOX 194000
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City | SAN JUAN
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State | PR
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Zip | 00919-4000
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Country | US
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Telephone | 787-775-2545
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | JORGE A RUIZ ROMAN
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Credential |
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Telephone | 787-775-2545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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