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General NPI Number Information
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NPI Number | 1215212469
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Entity Type | Organization
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Legal Business Name | JMMC MEDICAL GROUP, CP
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 2U5 AVE. LAUREL LOCAL 1 URB. LOMAS VERDES
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City | BAYAMON
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State | PR
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Zip | 00957
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Country | US
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Telephone | 787-604-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 2M8 AVE. LAUREL PMB 202 URB. LOMAS VERDES
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City | BAYAMON
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State | PR
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Zip | 00956-3341
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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 | VICEPRESIDENT
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Name | DR. MAYRA MERCEDES CASTA
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Credential | MD
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Telephone | 787-604-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 14334
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License Number State | PR
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