Healthcare Provider Details

I. General information

NPI: 1225147457
Provider Name (Legal Business Name): RICARDO JUAN JIMENEZ-LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARAMAR PLAZA SUITE 805
GUAYNABO PR
00969
US

IV. Provider business mailing address

PO BOX 362246
SAN JUAN PR
00936-2246
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-4070
  • Fax:
Mailing address:
  • Phone: 305-801-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number14168
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: