Healthcare Provider Details

I. General information

NPI: 1730164351
Provider Name (Legal Business Name): MILAGROS B. MARTIN - JIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILAGROS MARTIN - DE PUMAREJO MD

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 AVE DOMENECH
SAN JUAN PR
00918-3719
US

IV. Provider business mailing address

PARQUES DE SAN IGNACIO ST.1 C5
RIO PIEDRAS PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-1122
  • Fax: 787-758-1122
Mailing address:
  • Phone: 787-777-3535
  • Fax: 787-764-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6301
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number6301
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: