Healthcare Provider Details

I. General information

NPI: 1609841667
Provider Name (Legal Business Name): CARLOS E JIMENEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ASHFORD PRESBY HOSPITAL NUCLEAR MEDICINE LABORATORY 1ST FLOOR , ASHFORD AVE
SAN JUAN PR
00907
US

IV. Provider business mailing address

35 JUAN BORBON ST PMB 130
GUAYNABO PR
00969-5375
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-3500
  • Fax: 787-725-0485
Mailing address:
  • Phone: 787-724-3500
  • Fax: 787-725-0485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number11046
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number11046
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: