Provider Demographics
NPI:1568443919
Name:JIMENEZ RIVERA, JOSE DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DANIEL
Last Name:JIMENEZ RIVERA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:URBANIZACION FLAMINGO HILLS CALLE
Mailing Address - Street 2:MAIN A 28
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-787-4706
Mailing Address - Fax:787-787-4706
Practice Address - Street 1:CALLE 6 ESQUINA 13 BLOQUE H-1 OFICINA
Practice Address - Street 2:# 3 SANTA MONICA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-785-5454
Practice Address - Fax:787-785-5454
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11173208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0083718Medicare ID - Type Unspecified
G43021Medicare UPIN