Provider Demographics
NPI:1780898650
Name:JASAES MEDICAL DIAGNOSTIC INC.
Entity type:Organization
Organization Name:JASAES MEDICAL DIAGNOSTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-870-3080
Mailing Address - Street 1:90 AVE RIO HONDO
Mailing Address - Street 2:PMB STE 275
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3105
Mailing Address - Country:US
Mailing Address - Phone:787-870-3080
Mailing Address - Fax:
Practice Address - Street 1:CARR 165 KM 10.2
Practice Address - Street 2:STE 100 LILY MINI MALL
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR224843261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57368Medicare ID - Type UnspecifiedCARDIOVASCULAR CENTER