Provider Demographics
NPI:1558392753
Name:PEREZ JIMENEZ, EDITH NOEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:NOEMI
Last Name:PEREZ JIMENEZ
Suffix:
Gender:F
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 4673
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-4673
Mailing Address - Country:US
Mailing Address - Phone:787-407-9443
Mailing Address - Fax:
Practice Address - Street 1:BO. HOYAMALA STREET 119 KM. 28.6
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15524208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
2-2994Medicare ID - Type Unspecified
PRI-49004Medicare UPIN