Provider Demographics
NPI:1144388893
Name:JIMENEZ-CRUZ, JUAN CARLOS SR (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:JIMENEZ-CRUZ
Suffix:SR
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8057
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-8057
Mailing Address - Country:US
Mailing Address - Phone:787-833-2250
Mailing Address - Fax:787-833-2270
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1502
Practice Address - Country:US
Practice Address - Phone:787-833-2250
Practice Address - Fax:787-833-2270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27213Medicare ID - Type UnspecifiedOBGYN
PRC79634Medicare UPIN