Provider Demographics
NPI:1255809067
Name:JAMONPSC
Entity type:Organization
Organization Name:JAMONPSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-223-2795
Mailing Address - Street 1:URB LAS PALMAS DE CERRO GORDO CALLE ALEXANDRA 131
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:939-223-2795
Mailing Address - Fax:787-858-0818
Practice Address - Street 1:V3-46 CALLE SANDALIO ALONSO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3609
Practice Address - Country:US
Practice Address - Phone:787-706-0981
Practice Address - Fax:754-218-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063883510OtherSOCIAL WORKER
1295125029OtherGENERAL PHYSICIAN
1063883510OtherSOCIAL WORKER