Provider Demographics
NPI:1497782551
Name:JIMENEZ, HARRY O (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:O
Last Name:JIMENEZ
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 4211
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1211
Mailing Address - Country:US
Mailing Address - Phone:787-600-1051
Mailing Address - Fax:787-520-9750
Practice Address - Street 1:1667 CALLE VERBENA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6230
Practice Address - Country:US
Practice Address - Phone:787-600-1051
Practice Address - Fax:787-520-9750
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR95183Medicare ID - Type Unspecified
PRC83932Medicare UPIN