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General NPI Number Information
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NPI Number | 1528596897
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Entity Type | Organization
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Legal Business Name | JAB OPHTHALMICS, PSC
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | AVE DE DIEGO 150 SUITE 404
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-725-9315
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Fax | 787-724-4654
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Provider Business Mailing Address
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Address Line | PO BOX 41281
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City | SAN JUAN
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State | PR
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Zip | 00940-1281
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Country | US
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Telephone | 787-725-9315
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Fax | 787-724-4654
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Authorized Official
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Title or Position | OPHTHALMOLOGIST-PRESIDENT
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Name | MRS. MARIA HORTENSIA BERROCAL FERNANDEZ
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Credential | MD
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Telephone | 787-725-9315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 9358
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License Number State | PR
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