MEDICARE: DR. JUAN 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	207RP1001X	Pulmonary Disease Physician	6946	PR

General Provider Information

NPI Number	:	1659352631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN JIMENEZ MD

Provider Business Mailing Address
First Line	:	D20 CALLE QUEBRADA ARENAS
Second Line	:	URB EL PILAR
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5451
Country	:	US
Telephone Number	:	787-758-7245
Fax Number	:	787-753-7960

Provider Business Practice Location Address
First Line	:	452 AVE HOSTOS
Second Line	:	URB EL VEDADO
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3015
Country	:	US
Telephone Number	:	787-753-7980
Fax Number	:	787-753-7960

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	11/04/2009

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