Organization Name: | JLM MEDCORP.SERVICE,PSA |
NPI Number: | 1003994559 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAIME J. MOREL (PRESIDENT) |
Mailing Address: | 3026 Vereda Del Palmar Urb. Camino Del Mar Toa Baja |
State: | PR US |
Postal Code: | 009494371 |
Phone Number: | 7877957514 |
Fax Number: | 7877957514 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 15007 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |