Provider Demographics
NPI:1821109208
Name:JIMENEZ DIETSCH, RAMON E
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:E
Last Name:JIMENEZ DIETSCH
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:PO BOX 3681
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:787-257-6748
Mailing Address - Fax:
Practice Address - Street 1:CENTRO PEDIATRICO URB MONTE BEISAS
Practice Address - Street 2:STE 77 CALLE F
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-1112
Practice Address - Fax:787-801-1116
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2812213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist