Provider Demographics
NPI:1285153775
Name:JVC REHABILITATION MEDICINE SERVICES LLC
Entity type:Organization
Organization Name:JVC REHABILITATION MEDICINE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:NA
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-880-7411
Mailing Address - Street 1:PO BOX 140508
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0508
Mailing Address - Country:US
Mailing Address - Phone:787-880-7411
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 80.1
Practice Address - Street 2:ARECIBO MEDICAL CENTER
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19648208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1154761088Medicaid