Provider Demographics
NPI:1356347538
Name:ABOUELHOSSEN, JAMIL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIL
Middle Name:
Last Name:ABOUELHOSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TORRE SAN PABLO DEL ESTE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-863-3636
Mailing Address - Fax:787-863-3638
Practice Address - Street 1:TORRE SAN PABLO DEL ESTE
Practice Address - Street 2:SUITE 409
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-3636
Practice Address - Fax:787-863-3638
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3597-5OtherPROSSAM
PR7380059OtherHUMANA
PR060118OtherCRUZ AZUL DE PR
PR7380059OtherHUMANA INSURANCE
PR212190OtherPREFERRED
PR88422OtherSSS
PR116-11782OtherGLOBAL
PR500018SEOtherMMM
PRP534OtherFIRST MEDICAL
PRPE-3282OtherPALIC
PR88422Medicare UPIN