Provider Demographics
NPI:1780691238
Name:JIMENEZ, ROLANDO L (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:L
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2225 PONCE BYP
Mailing Address - Street 2:STE 706
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1321
Mailing Address - Country:US
Mailing Address - Phone:787-284-4830
Mailing Address - Fax:787-284-4814
Practice Address - Street 1:2225 PONCE BYP STE 706
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1379
Practice Address - Country:US
Practice Address - Phone:787-284-4830
Practice Address - Fax:787-284-4814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13846207RH0003X, 261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7995OtherFIRST PLUS PROVIDER ID
PR7310399OtherHUMANA INS PROV ID
PR84329JIOtherSSS MED ONCO ID
PR12011SOOtherSSS CHEMO FACILITY ID
PR12011SOOtherSSS CHEMO FACILITY ID
PR0084329Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER