Healthcare Provider Details

I. General information

NPI: 1376506071
Provider Name (Legal Business Name): JOSE RICARDO DE LEON-JIMENEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA CAROLINA MALL TERCER NIVEL SUITE 11
CAROLINA PR
00983
US

IV. Provider business mailing address

1357 AVE ASHFORD PMB 428
SAN JUAN PR
00907-2035
US

V. Phone/Fax

Practice location:
  • Phone: 787-776-1511
  • Fax: 787-776-1531
Mailing address:
  • Phone: 787-776-1511
  • Fax: 787-785-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number12876
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: