MEDICARE: CORAL KAOMA JIMENEZ ROVIRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	22627	PR

General Provider Information

NPI Number	:	1326665746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAL KAOMA JIMENEZ ROVIRA MD

Provider Business Mailing Address
First Line	:	1 AVE ALBOLOTE
Second Line	:	PLAZA REAL SHOPPING 202
City	:	GUAYNABO
State	:	PR
Zip	:	00969
Country	:	US
Telephone Number	:	939-373-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	PLAZA REAL SHOPPING CENTER
Second Line	:	SUITE 202
City	:	GUAYNABO
State	:	PR
Zip	:	00969
Country	:	US
Telephone Number	:	939-373-6791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	12/09/2025

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