Basic Information
| Provider Information | |||||||||
| NPI: | 1346825247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUTRAN MARTINEZ | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | CIRUGIA ORAL Y MAXILOFACIAL | ||||||||
| Address2: | PO BOX 365067 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009365067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582525 | ||||||||
| FaxNumber: | 7877510858 | ||||||||
| Practice Location | |||||||||
| Address1: | ASEM Y HOSPITAL UNIVERSITARIO DE ADULTOS | ||||||||
| Address2: | CENTRO MEDICO DE PR, BO. MONACILLOS | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2021 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 059-R | PR | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.