Healthcare Provider Details

I. General information

NPI: 1689641003
Provider Name (Legal Business Name): LAURA E JIMENEZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO LAS CUMBRES 349 AVE FELISA R DE GAUTIER STE.207
SAN JUAN PR
00926-6673
US

IV. Provider business mailing address

PASEO LAS CUMBRES 349 AVE FELISA R DE GAUTIER STE.207
SAN JUAN PR
00926-6673
US

V. Phone/Fax

Practice location:
  • Phone: 787-625-0707
  • Fax: 787-625-0705
Mailing address:
  • Phone: 787-625-0707
  • Fax: 787-625-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number375PR
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: