Provider Demographics
NPI:1750062360
Name:DELICE, JEAN A
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:DELICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:A
Other - Last Name:DELICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 AVE LUIS MUNOZ MARIN
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6184
Mailing Address - Country:US
Mailing Address - Phone:787-920-4090
Mailing Address - Fax:787-363-9900
Practice Address - Street 1:100 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6184
Practice Address - Country:US
Practice Address - Phone:787-920-4090
Practice Address - Fax:787-363-9900
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001190-P.A363AM0700X
AZ10073363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical