Provider Demographics
NPI:1255309134
Name:JIMENEZ, EMILIO JR (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:JIMENEZ
Suffix:JR
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:EMILIO
Other - Middle Name:
Other - Last Name:JIMENEZ ORTIZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD, FACOG
Mailing Address - Street 1:PO BOX 22678
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-2678
Mailing Address - Country:US
Mailing Address - Phone:787-763-1612
Mailing Address - Fax:787-753-7615
Practice Address - Street 1:6 CALLE JOSE FERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4404
Practice Address - Country:US
Practice Address - Phone:787-763-1612
Practice Address - Fax:787-753-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3363207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3363OtherMAPFRE
PR209155OtherPREFERRED HEALTH
PR9260002OtherHUMANA
PR94854JIOtherTRIPLE S
PR062010OtherCRUZ AZUL
PR3363OtherCOSVI
PR601385OtherMEDICARE Y MUCHO MAS(MMM)
PR3-3363OtherMCS
PR3-3363OtherMCS
PR3363OtherCOSVI