Provider Demographics
NPI:1750486825
Name:JIMENEZ RIVERA, JESSIE J (PT)
Entity Type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:J
Last Name:JIMENEZ RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BLVD MEDIA LUNA APT 1401
Mailing Address - Street 2:COND ALTURAS DEL PARQUE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-5087
Mailing Address - Country:US
Mailing Address - Phone:787-502-7422
Mailing Address - Fax:
Practice Address - Street 1:202 BLVD MEDIA LUNA APT 1401
Practice Address - Street 2:COND ALTURAS DEL PARQUE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-5087
Practice Address - Country:US
Practice Address - Phone:787-502-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR892171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor