Provider Demographics
NPI:1447394960
Name:GELY JIMENEZ CARDIOLOGOS CSP
Entity Type:Organization
Organization Name:GELY JIMENEZ CARDIOLOGOS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-745-2662
Mailing Address - Street 1:50 AVE L MUNOZ MARIN
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3975
Mailing Address - Country:US
Mailing Address - Phone:787-745-2666
Mailing Address - Fax:787-745-2662
Practice Address - Street 1:50 AVE L MUNOZ MARIN
Practice Address - Street 2:SUITE 303
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3975
Practice Address - Country:US
Practice Address - Phone:787-745-2666
Practice Address - Fax:787-745-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41096Medicare UPIN
PRE83761Medicare UPIN