Provider Demographics
NPI:1518975903
Name:MATEO JIMENEZ, LUIS ALBERTO
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:MATEO JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDAS HERMANAS MENA
Mailing Address - Street 2:CALLE VICTORIA 103
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-5708
Mailing Address - Country:US
Mailing Address - Phone:787-955-1807
Mailing Address - Fax:787-884-5858
Practice Address - Street 1:PASEOS DE ATENAS
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12309207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81412OtherSSS