Provider Demographics
NPI:1366472730
Name:PIMENTEL FERNANDEZ, JOSE LUCAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUCAS
Last Name:PIMENTEL FERNANDEZ
Suffix:
Gender:M
Credentials:MD
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 998
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0998
Mailing Address - Country:US
Mailing Address - Phone:787-864-4994
Mailing Address - Fax:787-864-7895
Practice Address - Street 1:#62 BALDORIOTY STREET
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-4860
Practice Address - Fax:787-864-7895
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5007208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery