Healthcare Provider Details

I. General information

NPI: 1447394960
Provider Name (Legal Business Name): GELY JIMENEZ CARDIOLOGOS CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 AVE L MUNOZ MARIN SUITE 303
CAGUAS PR
00725-3975
US

IV. Provider business mailing address

50 AVE L MUNOZ MARIN SUITE 303
CAGUAS PR
00725-3975
US

V. Phone/Fax

Practice location:
  • Phone: 787-745-2666
  • Fax: 787-745-2662
Mailing address:
  • Phone: 787-745-2666
  • Fax: 787-745-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8897
License Number StatePR

VIII. Authorized Official

Name: SANDRA LOPEZ
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-745-2662