Basic Information
| Provider Information | |||||||||
| NPI: | 1982124145 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JPM ENT SURGICAL LLC | ||||||||
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| OtherOrganizationName: | JPM ENT SURGICAL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23318 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009313318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874060301 | ||||||||
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| Practice Location | |||||||||
| Address1: | AVENIDA ASHFORD #1451 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877212160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 08/01/2017 | ||||||||
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| AuthorizedOfficialLastName: | PASCUAL MARRERO | ||||||||
| AuthorizedOfficialFirstName: | JEAMARIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7874060301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, MPH | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 019538 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.