Provider Demographics
NPI:1043477029
Name:JASKILLE MUJICA, AMIN D (MD)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:D
Last Name:JASKILLE MUJICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4980
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4980
Mailing Address - Country:US
Mailing Address - Phone:787-653-2219
Mailing Address - Fax:
Practice Address - Street 1:AVE LUIS MUNOZ MARIN, NUM 100
Practice Address - Street 2:URB MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-2219
Practice Address - Fax:787-653-1312
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR17919208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery