Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 17211 | PR |
NPI | 1013166784 |
---|---|
Provider Name | Dr. Jose Jaime Martell Cruz |
First Address | Coamo, PR 00769-1934 |
Second Address | Coamo, PR 00769-2416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 30/06/2020 |