Provider Demographics
NPI:1558316794
Name:JIMENEZ, RICARDO EMILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:EMILIO
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 1:138 RAFAEL COCA NAVAS, QUINTAS LAS MUESAS
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-0000
Mailing Address - Country:US
Mailing Address - Phone:787-263-8669
Mailing Address - Fax:787-263-4883
Practice Address - Street 1:60 AVE. BETANCE
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-0000
Practice Address - Country:US
Practice Address - Phone:787-738-2671
Practice Address - Fax:787-263-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE66425Medicare UPIN
PR82128Medicare ID - Type Unspecified