Provider Demographics
NPI:1790181667
Name:JUAN JOSE BAYRON JUSTINIANO, CSP
Entity type:Organization
Organization Name:JUAN JOSE BAYRON JUSTINIANO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:BAYRON JUSTINIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-783-0399
Mailing Address - Street 1:1791 CALLE ESTEBAN PADILLA
Mailing Address - Street 2:SANTIAGO IGLESIAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4237
Mailing Address - Country:US
Mailing Address - Phone:787-783-0399
Mailing Address - Fax:787-793-3965
Practice Address - Street 1:1791 CALLE ESTEBAN PADILLA
Practice Address - Street 2:SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4237
Practice Address - Country:US
Practice Address - Phone:787-783-0399
Practice Address - Fax:787-793-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11759OtherMEDICAL LICENSE
PR89042Medicare UPIN