Provider Demographics
NPI:1205878352
Name:JANIVE HEALTH SERVICES CSP
Entity type:Organization
Organization Name:JANIVE HEALTH SERVICES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-882-7001
Mailing Address - Street 1:PO BOX 250471
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604
Mailing Address - Country:US
Mailing Address - Phone:787-882-7001
Mailing Address - Fax:787-891-4767
Practice Address - Street 1:CALLE 110 KM. 0.3
Practice Address - Street 2:BARRIO CEIBA BAJA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00604
Practice Address - Country:US
Practice Address - Phone:787-882-7001
Practice Address - Fax:787-891-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH83771Medicare UPIN