Provider Demographics
NPI:1831142082
Name:JIMENEZ, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0340
Mailing Address - Country:US
Mailing Address - Phone:787-746-6460
Mailing Address - Fax:787-746-6467
Practice Address - Street 1:AVENIDA LUIS MUNOZ MARIN NUM 50
Practice Address - Street 2:QUADRANGLE MEDICAL CENTER SUITE 203
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-0340
Practice Address - Country:US
Practice Address - Phone:787-746-6460
Practice Address - Fax:787-746-6467
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6793207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85155OtherSSS
PR85155OtherSSS