Provider Demographics
NPI:1407974546
Name:JIMENEZ-VELAZQUEZ, IVONNE Z (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:Z
Last Name:JIMENEZ-VELAZQUEZ
Suffix:
Gender:F
Credentials:MD, FACP
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 9286
Mailing Address - Street 2:MEDICINA INTERNA RCM
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9286
Mailing Address - Country:US
Mailing Address - Phone:787-751-6034
Mailing Address - Fax:787-754-1763
Practice Address - Street 1:PLAZA CAROLINA MALL
Practice Address - Street 2:SUITE # 31
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-750-8920
Practice Address - Fax:787-750-8920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8243207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC82275Medicare UPIN
PR0029543Medicare PIN