Healthcare Provider Details

I. General information

NPI: 1053295816
Provider Name (Legal Business Name): CORALMEDPR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROCHELAISE CENTE OFICINA 3D WESTERN INDUSTRIAL PARK
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

8 VILLA GRACIA
MAYAGUEZ PR
00680-7171
US

V. Phone/Fax

Practice location:
  • Phone: 939-373-6791
  • Fax: 708-854-7667
Mailing address:
  • Phone: 939-373-6791
  • Fax: 708-854-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: CORAL KAOMA JIMENEZ ROVIRA
Title or Position: OWNER
Credential: MD
Phone: 939-373-6791