Provider Demographics
NPI:1952468126
Name:JCM PEDIATRIC HOSPITALIST SERVICES OF PUERTO RICO CSP
Entity Type:Organization
Organization Name:JCM PEDIATRIC HOSPITALIST SERVICES OF PUERTO RICO CSP
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:B-22 SOUTHVIEW CT.,
Mailing Address - Street 2:BALDWIN PARK
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-731-2721
Mailing Address - Fax:787-790-2518
Practice Address - Street 1:CARR #2 KM 11.9 INTERIOR BO. PAJAROS
Practice Address - Street 2:PUERTO RICO CHILDREN'S HOSPITAL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-974-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JCM PEDIATRIC HOSPITALIST SERVICES OF PUERTO RICO CSP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty