Provider Demographics
NPI:1154108975
Name:CANCEL, JAYMIE (MD)
Entity type:Individual
Prefix:
First Name:JAYMIE
Middle Name:
Last Name:CANCEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CALLE FERMIN GUZMAN
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1381
Mailing Address - Country:US
Mailing Address - Phone:787-562-9387
Mailing Address - Fax:
Practice Address - Street 1:207 CALLE FERMIN GUZMAN
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1381
Practice Address - Country:US
Practice Address - Phone:787-562-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23515208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice