Provider Demographics
NPI:1700056702
Name:CARLOS E. JIMENEZ HUYKE MD PSC
Entity Type:Organization
Organization Name:CARLOS E. JIMENEZ HUYKE MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-852-1358
Mailing Address - Street 1:PMB 500
Mailing Address - Street 2:100 GRAND POSEO BLVD 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-283-0804
Mailing Address - Fax:787-761-5764
Practice Address - Street 1:SUITE A-2 PROFESSIONAL PLAZA
Practice Address - Street 2:CARR 908 KM 0.4 BO. TEJAS
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-852-1358
Practice Address - Fax:787-850-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14798261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14798OtherPR MEDICAL LICENSE