Provider Demographics
NPI:1356020143
Name:JIMENEZ ORTEGA, YENIFER YESENIA (PA)
Entity type:Individual
Prefix:
First Name:YENIFER
Middle Name:YESENIA
Last Name:JIMENEZ ORTEGA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:URB. LEVITTWON LAKES
Mailing Address - Street 2:AA17 BLVD DAVID CORDOVA TORRECH FL2
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4555
Mailing Address - Country:US
Mailing Address - Phone:939-249-3509
Mailing Address - Fax:
Practice Address - Street 1:MARAMAR PLAZA STE 1060
Practice Address - Street 2:101 AVE SAN PATRICIO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2645
Practice Address - Country:US
Practice Address - Phone:787-474-0400
Practice Address - Fax:787-474-0408
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR001792-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant