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General NPI Number Information
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NPI Number | 1417054636
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Entity Type | Organization
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Legal Business Name | JARE SERVICIOS MEDICOS C S P
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 400 CALLE MANUEL DOMENECH STE 207 400 DOMENECH
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City | SAN JUAN
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State | PR
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Zip | 00918-3706
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Country | US
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Telephone | 787-765-3694
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191289
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City | SAN JUAN
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State | PR
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Zip | 00919-1289
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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 | PRESIDENT
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Name | DR. JOHNNY A RODRIGUEZ
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Credential | MD
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Telephone | 787-765-3694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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