Healthcare Provider Details

I. General information

NPI: 1114236437
Provider Name (Legal Business Name): JUAN CARLOS JIMENEZ PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-3738
US

IV. Provider business mailing address

572 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-3738
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2404
  • Fax: 787-764-4227
Mailing address:
  • Phone: 787-758-2404
  • Fax: 787-764-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18,288
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number18,288
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number18288
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: