Healthcare Provider Details

I. General information

NPI: 1962131565
Provider Name (Legal Business Name): MELISSA MARIE OWEN JIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA LOS SANTOS, V1 CALLE 16
ARECIBO PR
00612-3112
US

IV. Provider business mailing address

URB QUINTAS DEL RIO CALLE SENDA DE LA POSADA N10
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-1585
  • Fax: 787-815-2929
Mailing address:
  • Phone: 787-671-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23872
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: