Provider Demographics
NPI:1700560927
Name:VALLEJO, JONATHAN J I
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:J
Last Name:VALLEJO
Suffix:I
Gender:M
Credentials:
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 192825
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2825
Mailing Address - Country:US
Mailing Address - Phone:787-932-5550
Mailing Address - Fax:
Practice Address - Street 1:700 AVE ROBERTO H TODD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4807
Practice Address - Country:US
Practice Address - Phone:787-945-7710
Practice Address - Fax:787-945-7716
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2144101YP2500X
PR8202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional