Provider Demographics
NPI:1083769574
Name:CRESPO, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name:CRESPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-3009
Mailing Address - Country:US
Mailing Address - Phone:787-869-5130
Mailing Address - Fax:787-869-8236
Practice Address - Street 1:CENTRO COMERCIAL JARDINES
Practice Address - Street 2:CARR 164 KM 7.7
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3009
Practice Address - Country:US
Practice Address - Phone:787-869-5130
Practice Address - Fax:787-869-8236
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8081208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-81678Medicare UPIN
PR8-0715Medicare ID - Type Unspecified