Healthcare Provider Details

I. General information

NPI: 1437142403
Provider Name (Legal Business Name): LUIS E JIMENEZ BERROA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL MEDICAL CENTER
SAN JUAN PR
00936
US

IV. Provider business mailing address

PO BOX 8731 PLAZA CAROLINA STATION
CAROLINA PR
00988-8731
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-2223
  • Fax:
Mailing address:
  • Phone: 787-721-4836
  • Fax: 787-721-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11226
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: