1053430868 NPI number — OSVALDO JIMENEZ,M.D.,PSC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053430868 NPI number — OSVALDO JIMENEZ,M.D.,PSC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSVALDO JIMENEZ,M.D.,PSC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1053430868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 364807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-4807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-724-0550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 CALLE DE DIEGO
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00925-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-724-0550
Provider Business Practice Location Address Fax Number:
787-724-0561
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
OSVALDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-724-0550

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  6072 , 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)





Copyright © 2007-2025 www.npivalidator.com