Provider Demographics
NPI:1710761051
Name:JIMENEZ BERRIOS, GABRIEL ANTONIO
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANTONIO
Last Name:JIMENEZ BERRIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ND4 MANSION DEL NORTE
Mailing Address - Street 2:CALLE CAMINO DE VILLENA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ND4 MANSION DEL NORTE
Practice Address - Street 2:CALLE CAMINO DE VILLENA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4843
Practice Address - Country:US
Practice Address - Phone:787-477-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program