Healthcare Provider Details

I. General information

NPI: 1356805105
Provider Name (Legal Business Name): HIRAM JUDIEL JIMENEZ DAVILA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 11/07/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR. JOSE CELSO BALBOSA DRIVE
SAN JUAN PR
00921
US

IV. Provider business mailing address

CONDOMINIO PARQUE CENTRO EDIF CEIBA D10
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number16425-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: