Provider Demographics
NPI:1194905919
Name:ARENAS, JACK
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:ARENAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6381-7
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-9726
Mailing Address - Country:US
Mailing Address - Phone:787-879-1700
Mailing Address - Fax:787-878-1030
Practice Address - Street 1:HC 1 BOX 6381-7
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-9726
Practice Address - Country:US
Practice Address - Phone:787-879-1700
Practice Address - Fax:787-878-1030
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1469146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic