Provider Demographics
NPI:1023048535
Name:JAEN, RICARDO F (DPM)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:F
Last Name:JAEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:787-752-7740
Mailing Address - Fax:787-768-8392
Practice Address - Street 1:VIA G1, 5-A-4 URB VILLA FONTONA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-752-7740
Practice Address - Fax:787-276-6695
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U53065Medicare UPIN
48070Medicare ID - Type Unspecified