Provider Demographics
NPI:1336102920
Name:JIMENEZ-MERCADO, OSVALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:
Last Name:JIMENEZ-MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSVALDO
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:110 CALLE GUARAGUAO
Mailing Address - Street 2:URB. MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7101
Mailing Address - Country:US
Mailing Address - Phone:787-720-3344
Mailing Address - Fax:787-724-0561
Practice Address - Street 1:SAN JUAN HEALTH CTR
Practice Address - Street 2:SUITE 501 & 506 , DE DIEGO ST
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-724-0550
Practice Address - Fax:787-724-0561
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6072207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0097959Medicare PIN
PRD-26684Medicare UPIN