Provider Demographics
NPI:1730133349
Name:JIMENEZ-GONZALEZ, CRISTOBAL (MD)
Entity Type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:
Last Name:JIMENEZ-GONZALEZ
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:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1208
Mailing Address - Country:US
Mailing Address - Phone:787-863-5450
Mailing Address - Fax:787-655-2710
Practice Address - Street 1:#205 CELIS AQUILERA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-5450
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D33476Medicare UPIN
PR24948Medicare ID - Type Unspecified