Healthcare Provider Details

I. General information

NPI: 1568785673
Provider Name (Legal Business Name): FERNANDO JIMENEZ-TORRES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA CAROLINA 143-3 ST 401
CAROLINA PR
00985
US

IV. Provider business mailing address

VILLA CAROLINA 143-3 ST 401
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-200-5542
  • Fax:
Mailing address:
  • Phone: 787-200-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1798
License Number StatePR

VIII. Authorized Official

Name: DR. FERNANDO J JIMENEZ
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 787-200-5542