Provider Demographics
NPI:1932588464
Name:JS SPORT MEDICINE, PSC
Entity Type:Organization
Organization Name:JS SPORT MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:JIRAU ADAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DABPMR
Authorized Official - Phone:787-949-2933
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 345
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-705-1662
Mailing Address - Fax:
Practice Address - Street 1:576 CALLE CESAR GONZALEZ STE 502
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3758
Practice Address - Country:US
Practice Address - Phone:787-705-1662
Practice Address - Fax:787-425-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16739208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty