Jamonpsc | |
V3-46 Calle Sandalio Alonso San Juan PR 00921-3609 | |
(787) 706-0981 | |
(754) 218-0816 |
Full Name | Jamonpsc |
---|---|
Speciality | General Practice |
Location | V3-46 Calle Sandalio Alonso, San Juan, Puerto Rico |
Authorized Official Name and Position | Jaime Gabriel Rodriguez (GENERAL PHYSICIAN) |
Authorized Official Contact | 9392232795 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jamonpsc Urb Las Palmas De Cerro Gordo Calle Alexandra 131 Vega Alta PR 00692 Ph: (939) 223-2795 | Jamonpsc V3-46 Calle Sandalio Alonso San Juan PR 00921-3609 Ph: (787) 706-0981 |
NPI Number | 1255809067 |
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Provider Enumeration Date | 11/09/2018 |
Last Update Date | 10/26/2021 |
Certification Date | 10/26/2021 |
Medicare PECOS PAC ID | 9234599085 |
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Medicare Enrollment ID | O20230712002769 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255809067 | NPI | - | NPPES |
1063883510 | Other | SOCIAL WORKER | |
1295125029 | Other | GENERAL PHYSICIAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Jaime Gabriel Rodriguez |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1295125029 PECOS PAC ID: 3870819840 Enrollment ID: I20150310001861 |
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