Healthcare Provider Details

I. General information

NPI: 1407835770
Provider Name (Legal Business Name): CRISTINA JIMENEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 03 9888 BO PUEBLO
LARES PR
00669-9888
US

IV. Provider business mailing address

HC 03 9888 CARR 111 KM33.5 BO PUEBLO
LARES PR
00669-9888
US

V. Phone/Fax

Practice location:
  • Phone: 787-249-7431
  • Fax:
Mailing address:
  • Phone: 787-249-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14485
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: