Provider Demographics
NPI:1528596897
Name:JAB OPHTHALMICS, PSC
Entity Type:Organization
Organization Name:JAB OPHTHALMICS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:HORTENSIA
Authorized Official - Last Name:BERROCAL FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-725-9315
Mailing Address - Street 1:PO BOX 41281
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00940-1281
Mailing Address - Country:US
Mailing Address - Phone:787-725-9315
Mailing Address - Fax:787-724-4654
Practice Address - Street 1:AVE DE DIEGO 150 SUITE 404
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-9315
Practice Address - Fax:787-724-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9358207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty