Provider Demographics
NPI:1578557674
Name:JIMENEZ, JOSE LUIS II (EMT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:JIMENEZ
Suffix:II
Gender:M
Credentials:EMT
Other - Prefix:MRS
Other - First Name:NEREIDA
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0270
Mailing Address - Country:US
Mailing Address - Phone:787-280-0334
Mailing Address - Fax:787-280-0334
Practice Address - Street 1:4 CALLE DR PEDRO CEBOLLERO
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2265
Practice Address - Country:US
Practice Address - Phone:787-280-0334
Practice Address - Fax:787-280-0334
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAMB279146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059015Medicare ID - Type UnspecifiedPROVIDER NUMBER