Provider Demographics
NPI:1609841667
Name:JIMENEZ, CARLOS E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:35 JUAN BORBON ST
Mailing Address - Street 2:PMB 130
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5375
Mailing Address - Country:US
Mailing Address - Phone:787-724-3500
Mailing Address - Fax:787-725-0485
Practice Address - Street 1:ASHFORD PRESBY HOSPITAL NUCLEAR MEDICINE LABORATORY
Practice Address - Street 2:1ST FLOOR , ASHFORD AVE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-724-3500
Practice Address - Fax:787-725-0485
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11046207RS0010X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20885Medicare ID - Type Unspecified