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General NPI Number Information
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NPI Number | 1881932838
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Entity Type | Organization
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Legal Business Name | JDDM INC
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Dates
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Enumeration Date | 01/26/2013
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Last Update Date | 01/26/2013
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Provider Practice Location Address
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Address Line | 210 AVE CARLOS CHARDON STE 104
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City | SAN JUAN
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State | PR
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Zip | 00918-1716
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Country | US
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Telephone | 787-756-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 210 AVE CARLOS CHARDON STE 104
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City | SAN JUAN
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State | PR
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Zip | 00918-1716
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Country | US
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Telephone | 787-756-2121
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. JOSE C RODRIGUEZ-PORTELA
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Credential | DPM
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Telephone | 787-344-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 103
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License Number State | PR
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