Provider Demographics
NPI:1447413257
Name:JIMENEZ REYES, RICARDO E (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:E
Last Name:JIMENEZ REYES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND MIRAMAR EMBASSY 902 PONCE DE LEON AVENUE
Mailing Address - Street 2:APT 606
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-723-3013
Mailing Address - Fax:
Practice Address - Street 1:COND MIRAMAR EMBASSY
Practice Address - Street 2:902 PONCE DE LEON AVE. APT. 606
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3367
Practice Address - Country:US
Practice Address - Phone:787-723-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2258103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical