Provider Demographics
NPI:1063686368
Name:JGM PSYCHIATRY SERVICES
Entity Type:Organization
Organization Name:JGM PSYCHIATRY SERVICES
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAPHET
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZTAMBIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-265-0370
Mailing Address - Street 1:MENDEZ VIGO 63 E
Mailing Address - Street 2:COND. CENTRO PLAZA OFIC. 5A
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-265-0370
Mailing Address - Fax:787-265-0370
Practice Address - Street 1:COND MENDEZ VIGO W # 63E
Practice Address - Street 2:COND. CENTRO PLAZA OFIC. 5A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-2800
Practice Address - Country:US
Practice Address - Phone:787-265-0370
Practice Address - Fax:787-265-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11940261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health