Healthcare Provider Details

I. General information

NPI: 1962392076
Provider Name (Legal Business Name): MARIANGELLY JIMENEZ RIVERA MD, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. EST. PR-460, KM 0.2, BO. CAIMITO BAJO,
AGUADILLA PR
00603
US

IV. Provider business mailing address

71 CALLE FELIX RAMOS VELEZ
ISABELA PR
00662-3418
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-0200
  • Fax:
Mailing address:
  • Phone: 787-943-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25186
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: