Provider Demographics
NPI:1457447575
Name:JIMENEZ RIVERA, BRENDA MONSERRATE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MONSERRATE
Last Name:JIMENEZ RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 V-11 ALTURAS DE FLAMBOYAN
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-222-3935
Mailing Address - Fax:
Practice Address - Street 1:12 V-11 ALTURAS DE FLAMBOYAN
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-222-3935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14364208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21260OtherSSS
1436YLICMedicare UPIN
PR21260OtherSSS