Healthcare Provider Details

I. General information

NPI: 1548262264
Provider Name (Legal Business Name): DR. FELIX A JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CARR 2 SUITE 410
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

1845 CARR 2 SUITE 410
BAYAMON PR
00959-7200
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-5160
  • Fax: 787-787-5544
Mailing address:
  • Phone: 787-787-5160
  • Fax: 787-787-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number5344
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: