Provider Demographics
NPI:1891731675
Name:JIMENEZ VELEZ, AITSA (MD)
Entity Type:Individual
Prefix:
First Name:AITSA
Middle Name:
Last Name:JIMENEZ VELEZ
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:RR 4 BOX 699
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9636
Mailing Address - Country:US
Mailing Address - Phone:787-764-3553
Mailing Address - Fax:787-754-0155
Practice Address - Street 1:100 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6184
Practice Address - Country:US
Practice Address - Phone:787-744-8686
Practice Address - Fax:787-258-1258
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11852207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH40972Medicare UPIN
PR0020562Medicare PIN