Provider Demographics
NPI:1891718482
Name:LOUBRIEL JIMENEZ, MARIETTA (MD)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:LOUBRIEL JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 CALLE ANON
Mailing Address - Street 2:HIGHLAND PARK
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5141
Mailing Address - Country:US
Mailing Address - Phone:787-751-7703
Mailing Address - Fax:
Practice Address - Street 1:721 CALLE ANON
Practice Address - Street 2:HIGHLAND PARK
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924-5141
Practice Address - Country:US
Practice Address - Phone:787-751-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4845208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28779Medicare ID - Type Unspecified
PRD32947Medicare UPIN