Provider Demographics
NPI:1144667213
Name:JEV PROFESSIONAL HEALTHCARE PSC
Entity type:Organization
Organization Name:JEV PROFESSIONAL HEALTHCARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:VELEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-264-9806
Mailing Address - Street 1:2122 CALLE ONFALA
Mailing Address - Street 2:ALTO APOLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4932
Mailing Address - Country:US
Mailing Address - Phone:787-264-9806
Mailing Address - Fax:
Practice Address - Street 1:2122 CALLE ONFALA
Practice Address - Street 2:ALTO APOLO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4932
Practice Address - Country:US
Practice Address - Phone:787-264-9806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17086208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28622OtherPTAN MEDICARE