Healthcare Provider Details

I. General information

NPI: 1578557674
Provider Name (Legal Business Name): JOSE LUIS JIMENEZ II E.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: NEREIDA RAMOS I R.N.

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CALLE DR PEDRO CEBOLLERO
SAN SEBASTIAN PR
00685-2265
US

IV. Provider business mailing address

PO BOX 270
SAN SEBASTIAN PR
00685-0270
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-0334
  • Fax: 787-280-0334
Mailing address:
  • Phone: 787-280-0334
  • Fax: 787-280-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberAMB279
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: