Provider Demographics
NPI:1710203351
Name:JCM PEDIATRIC HOSPITALIST SERVICES OF PUERTO RICO
Entity Type:Organization
Organization Name:JCM PEDIATRIC HOSPITALIST SERVICES OF PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CANTELLOPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-731-2721
Mailing Address - Street 1:B22 SOUTHVIEW CT
Mailing Address - Street 2:URB. BALDWIN PARK
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4118
Mailing Address - Country:US
Mailing Address - Phone:787-731-2721
Mailing Address - Fax:787-790-2518
Practice Address - Street 1:PUERTO RICO CHILDREN HOSPITAL
Practice Address - Street 2:CARR. #2 KM 11.7
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-474-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10867282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1033162300OtherNPI
PR1073578068OtherNPI
PR1225006273OtherNPI
1225006273OtherNPI
PR1700939543OtherNPI
PR1104860386OtherNPI