Provider Demographics
NPI:1235141433
Name:JIMENEZ, AMALIO
Entity Type:Individual
Prefix:DR
First Name:AMALIO
Middle Name:
Last Name: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 1:326 CALLE JOSE OLMO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4875
Mailing Address - Country:US
Mailing Address - Phone:787-880-4799
Mailing Address - Fax:787-880-4799
Practice Address - Street 1:326 CALLE JOSE OLMO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4875
Practice Address - Country:US
Practice Address - Phone:787-880-4799
Practice Address - Fax:787-880-4799
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0035098Medicare ID - Type Unspecified