Provider Demographics
NPI:1851597355
Name:JIMINEZ ALFONZO, LEIDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIDA
Middle Name:M
Last Name:JIMINEZ ALFONZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEIDA
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1680
Mailing Address - Country:US
Mailing Address - Phone:787-309-8648
Mailing Address - Fax:
Practice Address - Street 1:128 ASHFORD
Practice Address - Street 2:ASHFORD MEDICAL BUILDING SUITE 201
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-309-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10943208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2454236OtherHUMANA
PR84603Medicare PIN
PR2454236OtherHUMANA