Provider Demographics
NPI:1265025225
Name:JAG MEDICAL LLC
Entity Type:Organization
Organization Name:JAG MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-226-8490
Mailing Address - Street 1:364 CALLE SAN JORGE , COND LAS CARMELITAS
Mailing Address - Street 2:APT 3E
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912
Mailing Address - Country:US
Mailing Address - Phone:787-226-8490
Mailing Address - Fax:
Practice Address - Street 1:364 SAN JORGE ST, COND LAS CARMELITAS
Practice Address - Street 2:APT 3E
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-0091
Practice Address - Country:US
Practice Address - Phone:787-226-8490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty