MEDICARE: DR. OMAR ANTONIO CRESPO JIMENEZ 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	208D00000X	General Practice Physician	21040	PR

General Provider Information

NPI Number	:	1730666827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMAR ANTONIO CRESPO JIMENEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 4465
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00605-4465
Country	:	US
Telephone Number	:	939-366-4563
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 URB VISTA VERDE
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-6458
Country	:	US
Telephone Number	:	939-366-4563
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	05/05/2026

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