Provider Demographics
NPI:1114943305
Name:JIMENEZ MEJIA, JARIS J (MD)
Entity Type:Individual
Prefix:
First Name:JARIS
Middle Name:J
Last Name:JIMENEZ MEJIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 73
Mailing Address - Street 2:382 SAN CLAUDIO AVENUE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9910
Mailing Address - Country:US
Mailing Address - Phone:787-638-1618
Mailing Address - Fax:787-754-1059
Practice Address - Street 1:382 SAN CLAUDIO AVENUE
Practice Address - Street 2:PMB 73
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9910
Practice Address - Country:US
Practice Address - Phone:787-638-1618
Practice Address - Fax:787-754-1059
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15322208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23128Medicare ID - Type Unspecified