MEDICARE: ANIRMA FRANCISCA JAQUEZ MD

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	15559	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DM15464-8	OTHER	PR	AMSCA

General Provider Information

NPI Number	:	1558488189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIRMA FRANCISCA JAQUEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 3030
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-3030
Country	:	US
Telephone Number	:	787-831-5479
Fax Number	:	787-831-5479

Provider Business Practice Location Address
First Line	:	52 CALLE DE DIEGO W
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4733
Country	:	US
Telephone Number	:	787-831-5479
Fax Number	:	787-831-5479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/07/2023

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