Provider Demographics
NPI:1154082048
Name:NADAL, JAIME ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ENRIQUE
Last Name:NADAL
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:URB. VEREDAS
Mailing Address - Street 2:#333 CALLE 19
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-405-5094
Mailing Address - Fax:
Practice Address - Street 1:1399 AVE ANA G MENDEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2602
Practice Address - Country:US
Practice Address - Phone:787-405-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22635208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice