1184819773 NPI number — EDIL O JIMENEZ-PEREZ M.D.

Table of content: EDIL O JIMENEZ-PEREZ M.D. (NPI 1184819773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184819773 NPI number — EDIL O JIMENEZ-PEREZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ-PEREZ
Provider First Name:
EDIL
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184819773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
261 DORADO BCH E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-475-3747
Provider Business Mailing Address Fax Number:
787-854-1452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAYAMON MEDICAL PLAZA STE 701
Provider Second Line Business Practice Location Address:
CARR #2 KM 11.7
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-5500
Provider Business Practice Location Address Fax Number:
787-787-2101
Provider Enumeration Date:
09/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  0101252032 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 18438 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)