Provider Demographics
NPI:1659352631
Name:JIMENEZ, JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
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:D20 CALLE QUEBRADA ARENAS
Mailing Address - Street 2:URB EL PILAR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5451
Mailing Address - Country:US
Mailing Address - Phone:787-758-7245
Mailing Address - Fax:787-753-7960
Practice Address - Street 1:452 AVE HOSTOS
Practice Address - Street 2:URB EL VEDADO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3015
Practice Address - Country:US
Practice Address - Phone:787-753-7980
Practice Address - Fax:787-753-7960
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6946207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0098741Medicare ID - Type Unspecified
C78245Medicare UPIN