MEDICARE: DR. JACA MONTIJO CSP

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	207RG0100X	Gastroenterology Physician	13094	PR
2	261QE0800X	Endoscopy Clinic/Center	13094	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730439886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JACA MONTIJO CSP

Provider Business Mailing Address
First Line	:	1995 CARR 2 STE 2903
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959-5062
Country	:	US
Telephone Number	:	787-395-7500
Fax Number	:	787-395-7501

Provider Business Practice Location Address
First Line	:	METROMEDICAL
Second Line	:	SUITE 903
City	:	BAYAMON
State	:	PR
Zip	:	00959-5065
Country	:	US
Telephone Number	:	787-935-7500
Fax Number	:	787-395-7501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IGNACIO JACA
Credential	:	M.D.
Telephone Number	:	787-559-5212

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	03/11/2019

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