Provider Demographics
NPI:1003883919
Name:SANDOVAL JIMENEZ, AMARILYS (OD)
Entity Type:Individual
Prefix:DR
First Name:AMARILYS
Middle Name:
Last Name:SANDOVAL JIMENEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HACIENDA TERRA LINDA
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9760
Mailing Address - Country:US
Mailing Address - Phone:787-291-7191
Mailing Address - Fax:
Practice Address - Street 1:CARR 484 KM0.1
Practice Address - Street 2:BO COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-5724
Practice Address - Country:US
Practice Address - Phone:787-291-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist