Provider Demographics
NPI:1114966942
Name:PROFFESSIONAL MEDICS
Entity Type:Organization
Organization Name:PROFFESSIONAL MEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CEBALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-794-5523
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-1536
Mailing Address - Country:US
Mailing Address - Phone:787-794-5523
Mailing Address - Fax:
Practice Address - Street 1:ALELI STREET LOT 4-A
Practice Address - Street 2:BARRIO INGENIO
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-794-5523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50007Medicare ID - Type Unspecified