Provider Demographics
NPI:1467488379
Name:JIMENEZ- ORTEGA, OBET (MD)
Entity Type:Individual
Prefix:DR
First Name:OBET
Middle Name:
Last Name:JIMENEZ- ORTEGA
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 850
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0850
Mailing Address - Country:US
Mailing Address - Phone:787-898-5584
Mailing Address - Fax:787-898-5584
Practice Address - Street 1:121 AVE DR SUSONI
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1843
Practice Address - Country:US
Practice Address - Phone:787-262-8526
Practice Address - Fax:787-898-1592
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR341600000X
PR15074208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022079OtherTRIPLE S /MEDICARE
PR0057383Medicare PIN
PR0022079OtherTRIPLE S /MEDICARE