Provider Demographics
NPI:1376514653
Name:AMPARO, JESUS R
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:R
Last Name:AMPARO
Suffix:
Gender:M
Credentials:
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 11368
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1368
Mailing Address - Country:US
Mailing Address - Phone:787-785-4686
Mailing Address - Fax:787-785-4686
Practice Address - Street 1:BAYAMON MEDICAL PLAZA
Practice Address - Street 2:SUITE 509
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-785-4686
Practice Address - Fax:787-785-4686
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41010Medicare UPIN
PR0088630Medicare PIN