Provider Demographics
NPI:1649288408
Name:JIMENEZ ZAMBRANO, ARIEL (MD)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:JIMENEZ ZAMBRANO
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:PO BOX 0044
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-5922
Mailing Address - Fax:787-621-9700
Practice Address - Street 1:BO CANTERA #22
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-5922
Practice Address - Fax:787-621-9700
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14262208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21555Medicare ID - Type Unspecified
H90101Medicare UPIN