Provider Demographics
NPI:1518915024
Name:DE FRIAS JIMENEZ, FIDEL C (MD)
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:C
Last Name:DE FRIAS 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 5183
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:787-882-6950
Mailing Address - Fax:787-882-6950
Practice Address - Street 1:27 AVE SEVERIANO CUEVAS
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-6950
Practice Address - Fax:787-891-2365
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6708207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0098700Medicare ID - Type Unspecified
0098700Medicare ID - Type Unspecified