Healthcare Provider Details

I. General information

NPI: 1326665746
Provider Name (Legal Business Name): CORAL KAOMA JIMENEZ ROVIRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
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 Number22627
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: