Basic Information
| Provider Information | |||||||||
| NPI: | 1053761353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHICLANA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 82 CALLE AZUCENA | ||||||||
| Address2: | ESTANCIAS DE LA FUENTE | ||||||||
| City: | TOA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009533611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878109742 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 AVE LAUREL | ||||||||
| Address2: | CUMIC, SANTA JUANITA | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009564816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877983001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2016 | ||||||||
| LastUpdateDate: | 06/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 144 | PR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.