MEDICARE: JLM MEDCORP.SERVICE,PSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	15007	PR

General Provider Information

NPI Number	:	1003994559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JLM MEDCORP.SERVICE,PSA

Provider Business Mailing Address
First Line	:	3026 VEREDA DEL PALMAR
Second Line	:	URB. CAMINO DEL MAR
City	:	TOA BAJA
State	:	PR
Zip	:	00949-4371
Country	:	US
Telephone Number	:	787-795-7514
Fax Number	:	787-795-7514

Provider Business Practice Location Address
First Line	:	3026 VEREDA DEL PALMAR
Second Line	:	URB. CAMINO DEL MAR
City	:	TOA BAJA
State	:	PR
Zip	:	00949-4371
Country	:	US
Telephone Number	:	787-795-7514
Fax Number	:	787-795-7514

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAIME J. MOREL
Credential	:	M.D.
Telephone Number	:	787-795-7514

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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