Provider Demographics
NPI:1083218259
Name:REYES JIMENEZ, CARMEN JOHANNA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:JOHANNA
Last Name:REYES JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:JOHANNA
Other - Last Name:REYES JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 CALLE VERANO
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-3073
Mailing Address - Country:US
Mailing Address - Phone:787-602-6925
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE VERANO
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3073
Practice Address - Country:US
Practice Address - Phone:787-602-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36359390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program