Provider Demographics
NPI:1013793587
Name:JD PRIMARY CARE CENTER CORP
Entity Type:Organization
Organization Name:JD PRIMARY CARE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-223-2253
Mailing Address - Street 1:77 CALLE MUNOZ RIVERA ESQ MARIO BRASCHI
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1613
Mailing Address - Country:US
Mailing Address - Phone:787-580-7329
Mailing Address - Fax:
Practice Address - Street 1:77 CALLE MUNOZ RIVERA ESQ MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1613
Practice Address - Country:US
Practice Address - Phone:787-580-7329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty