Provider Demographics
NPI:1033116306
Name:CAMPIZ JIMENEZ, LEONARDO J
Entity Type:Individual
Prefix:DR
First Name:LEONARDO J
Middle Name:
Last Name:CAMPIZ JIMENEZ
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 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-723-7813
Mailing Address - Fax:
Practice Address - Street 1:550 AVE DOMENECH
Practice Address - Street 2:HOSPITAL DEL MAESTRO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3733
Practice Address - Country:US
Practice Address - Phone:787-753-7123
Practice Address - Fax:787-758-0105
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9871208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00883117Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
PRF99367Medicare UPIN