Provider Demographics
NPI:1003994559
Name:JLM MEDCORP.SERVICE,PSA
Entity Type:Organization
Organization Name:JLM MEDCORP.SERVICE,PSA
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-795-7514
Mailing Address - Street 1:3026 VEREDA DEL PALMAR
Mailing Address - Street 2:URB. CAMINO DEL MAR
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4371
Mailing Address - Country:US
Mailing Address - Phone:787-795-7514
Mailing Address - Fax:787-795-7514
Practice Address - Street 1:3026 VEREDA DEL PALMAR
Practice Address - Street 2:URB. CAMINO DEL MAR
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4371
Practice Address - Country:US
Practice Address - Phone:787-795-7514
Practice Address - Fax:787-795-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15007208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty