Provider Demographics
NPI:1134104839
Name:SANCHEZ, JOSE JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JUAN
Last Name:SANCHEZ
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 2103
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-2103
Mailing Address - Country:US
Mailing Address - Phone:787-833-5050
Mailing Address - Fax:787-833-5050
Practice Address - Street 1:COND MENDEZ VIGO W
Practice Address - Street 2:COND CENTRO PLAZA OFFIC 3-B
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-2800
Practice Address - Country:US
Practice Address - Phone:787-833-5050
Practice Address - Fax:787-833-5050
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6447174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58436001Medicare UPIN