MEDICARE: MARIETTA LOUBRIEL 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	4845	PR

General Provider Information

NPI Number	:	1891718482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIETTA LOUBRIEL JIMENEZ MD

Provider Business Mailing Address
First Line	:	721 CALLE ANON
Second Line	:	HIGHLAND PARK
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00924-5141
Country	:	US
Telephone Number	:	787-751-7703
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 CALLE ANON
Second Line	:	HIGHLAND PARK
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00924-5141
Country	:	US
Telephone Number	:	787-751-7703
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/25/2011

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