MEDICARE: DR. RICKY JIMENEZ MD

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	207RG0100X	Gastroenterology Physician	12272	PR

General Provider Information

NPI Number	:	1457352890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICKY JIMENEZ MD

Provider Business Mailing Address
First Line	:	1047 CALLE CARITE
Second Line	:	URB. VALLES DEL LAGO
City	:	CAGUAS
State	:	PR
Zip	:	00725-7645
Country	:	US
Telephone Number	:	787-747-0246
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 CALLE WASHINGTON
Second Line	:	ASHFORD MEDICAL CENTER SUITE 202
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1510
Country	:	US
Telephone Number	:	787-977-5011
Fax Number	:	787-977-5062

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/16/2010

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