Provider Demographics
NPI:1851506018
Name:JIMENEZ MARTE, VIRGILIO (0719P)
Entity Type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:
Last Name:JIMENEZ MARTE
Suffix:
Gender:M
Credentials:0719P
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 2161
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-2161
Mailing Address - Country:US
Mailing Address - Phone:787-754-2550
Mailing Address - Fax:787-781-2063
Practice Address - Street 1:90 CALLE SAN MARTIN
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1400
Practice Address - Country:US
Practice Address - Phone:787-754-2550
Practice Address - Fax:787-781-2063
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0719P146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic