Provider Demographics
NPI:1699882720
Name:ATENCIO, JEREMIAS A
Entity type:Individual
Prefix:
First Name:JEREMIAS
Middle Name:A
Last Name:ATENCIO
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:OCEAN PARKV C/ TAPIA #61
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-727-4674
Mailing Address - Fax:
Practice Address - Street 1:107 CALLE SANTA CECILIA
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00911-2202
Practice Address - Country:US
Practice Address - Phone:787-727-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15412208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice