Provider Demographics
NPI:1710961453
Name:DR JUAN A JURADO C S P
Entity Type:Organization
Organization Name:DR JUAN A JURADO C S P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JURADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-863-3040
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0669
Mailing Address - Country:US
Mailing Address - Phone:787-863-3040
Mailing Address - Fax:787-860-5906
Practice Address - Street 1:AVE GENERAL VALERO 375
Practice Address - Street 2:SUITE 106
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0669
Practice Address - Country:US
Practice Address - Phone:787-863-3040
Practice Address - Fax:787-860-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3608207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE11491Medicare UPIN
PR0094766Medicare PIN