Healthcare Provider Details

I. General information

NPI: 1053562488
Provider Name (Legal Business Name): LUIS A JIMENEZ REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LUIS MUNOZ MARIN STE 305
CAGUAS PR
00725-6184
US

IV. Provider business mailing address

PO BOX 191855
SAN JUAN PR
00919-1855
US

V. Phone/Fax

Practice location:
  • Phone: 787-920-4090
  • Fax:
Mailing address:
  • Phone: 787-342-4736
  • Fax: 877-736-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number17995
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: