=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700758745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JD RENAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2025
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | B1 CALLE 1
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729-4116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-886-3254
-----------------------------------------------------
Fax | 787-957-1555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | A8 VIA HORIZONTE URB LA VISTA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00924-4461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-886-3254
-----------------------------------------------------
Fax | 787-957-1555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JOSE D ORTIZ ROSARIO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-886-3254
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------