Provider Demographics
NPI:1932175841
Name:O'NEILL, JEAMILETTE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JEAMILETTE
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:AUD
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 714
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0714
Mailing Address - Country:US
Mailing Address - Phone:787-284-7792
Mailing Address - Fax:787-290-6400
Practice Address - Street 1:2431 BULEVAR LUIS A FERRE
Practice Address - Street 2:EDIFICIO PORRATA SUITE 200
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-284-7792
Practice Address - Fax:787-290-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRP68453Medicare UPIN
PR0021121Medicare ID - Type Unspecified