Provider Demographics
NPI:1831809649
Name:JA MEDICAL CENTER, INC
Entity type:Organization
Organization Name:JA MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-987-8031
Mailing Address - Street 1:61 CALLE REY FERNANDO
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-4006
Mailing Address - Country:US
Mailing Address - Phone:787-987-8031
Mailing Address - Fax:787-987-8032
Practice Address - Street 1:2-18 CALLE MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-987-8031
Practice Address - Fax:787-987-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17075OtherMEDICAL LICENSE