MEDICARE: JAA MEDICAL SERVICES 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	174400000X	Specialist

General Provider Information

NPI Number	:	1932309143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAA MEDICAL SERVICES CSP

Provider Business Mailing Address
First Line	:	REPARTO ANAIDA 4-C20
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-2534
Country	:	US
Telephone Number	:	787-848-7604
Fax Number	:	787-848-7604

Provider Business Practice Location Address
First Line	:	1243 AVE MUNOZ RIVERA
Second Line	:	VILLA GRILLASCA
City	:	PONCE
State	:	PR
Zip	:	00717-0634
Country	:	US
Telephone Number	:	787-848-7604
Fax Number	:	787-848-7604

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JORGE G. ANGLERO
Credential	:	MD
Telephone Number	:	787-848-7604

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	02/08/2012

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