MEDICARE: MIRIAM JEREZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1891106688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM JEREZ

Provider Business Mailing Address
First Line	:	700 CALLE DR PAVIA
Second Line	:	SUITE 205
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 CALLE DR PAVIA
Second Line	:	SUITE 205
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2857
Country	:	US
Telephone Number	:	787-982-5328
Fax Number	:

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

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	05/14/2014

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Directions to “ MIRIAM JEREZ ” Practice Location

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