Provider Demographics
NPI:1194033001
Name:JIMENEZ BARRETO, OMAYRA (LND)
Entity Type:Individual
Prefix:MRS
First Name:OMAYRA
Middle Name:
Last Name:JIMENEZ BARRETO
Suffix:
Gender:F
Credentials:LND
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 6157
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-6157
Mailing Address - Country:US
Mailing Address - Phone:787-261-1169
Mailing Address - Fax:
Practice Address - Street 1:JR1 CALLE LIZZIE GRAHAM
Practice Address - Street 2:LEVITTOWN 7MA SEC
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3637
Practice Address - Country:US
Practice Address - Phone:787-261-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1242133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered