Provider Demographics
NPI:1992468243
Name:JIMENEZ-OCASIO, JUAN J (MD - PA)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:J
Last Name:JIMENEZ-OCASIO
Suffix:
Gender:M
Credentials:MD - PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URUGUAY Q-644
Mailing Address - Street 2:EXT FOREST HILLS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URUGUAY Q-644
Practice Address - Street 2:EXT FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:UM
Practice Address - Phone:787-638-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR482363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical