Provider Demographics
NPI:1689948580
Name:JAVA MED, P.S.C.
Entity Type:Organization
Organization Name:JAVA MED, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENARO
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELEZ-ARTEAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-390-3636
Mailing Address - Street 1:PO BOX 270183
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-2983
Mailing Address - Country:US
Mailing Address - Phone:787-390-3636
Mailing Address - Fax:787-390-3636
Practice Address - Street 1:E17 CALLE TEODORO MEDINA
Practice Address - Street 2:URB. CELINA
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735
Practice Address - Country:US
Practice Address - Phone:787-390-3636
Practice Address - Fax:787-390-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16965261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care