Provider Demographics
NPI:1366633315
Name:JURADO, JUAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:JURADO
Suffix:
Gender:M
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0669
Mailing Address - Country:US
Mailing Address - Phone:787-863-3040
Mailing Address - Fax:
Practice Address - Street 1:AVE GENERAL VALERO 375
Practice Address - Street 2:SUITE 106
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0669
Practice Address - Country:US
Practice Address - Phone:787-863-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3608207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR94766OtherTRIPLE S PIN
PRE11491Medicare UPIN
PR94766OtherTRIPLE S PIN