MEDICARE: MRS. OMAYRA JIMENEZ BARRETO LND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1242	PR

General Provider Information

NPI Number	:	1194033001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OMAYRA JIMENEZ BARRETO LND

Provider Business Mailing Address
First Line	:	PO BOX 6157
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00914-6157
Country	:	US
Telephone Number	:	787-261-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	JR1 CALLE LIZZIE GRAHAM
Second Line	:	LEVITTOWN 7MA SEC
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3637
Country	:	US
Telephone Number	:	787-261-1169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	09/14/2010

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