Provider Demographics
NPI:1316262397
Name:JALOU INC
Entity type:Organization
Organization Name:JALOU INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-767-4200
Mailing Address - Street 1:AVE.PONCE DE LEON 735, STE 25
Mailing Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-767-4200
Mailing Address - Fax:787-767-4200
Practice Address - Street 1:AVE.PONCE DE LEON 735, SUITE 25
Practice Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-767-4200
Practice Address - Fax:787-767-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty