Provider Demographics
NPI:1477089100
Name:JIMENEZ, YARA
Entity Type:Individual
Prefix:
First Name:YARA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CALLE PATRON
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-3021
Mailing Address - Country:US
Mailing Address - Phone:787-862-3000
Mailing Address - Fax:787-862-2731
Practice Address - Street 1:2 CALLE PATRON
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3021
Practice Address - Country:US
Practice Address - Phone:787-862-3000
Practice Address - Fax:787-862-2731
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04912471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-2747Medicare PIN