Provider Demographics
NPI:1457352890
Name:JIMENEZ, RICKY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 CALLE CARITE
Mailing Address - Street 2:URB. VALLES DEL LAGO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7645
Mailing Address - Country:US
Mailing Address - Phone:787-747-0246
Mailing Address - Fax:
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:ASHFORD MEDICAL CENTER SUITE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-977-5011
Practice Address - Fax:787-977-5062
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12272207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89074Medicare ID - Type Unspecified