1194033001 NPI number — MRS. OMAYRA JIMENEZ BARRETO LND

Table of content: MRS. OMAYRA JIMENEZ BARRETO LND (NPI 1194033001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194033001 NPI number — MRS. OMAYRA JIMENEZ BARRETO LND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ BARRETO
Provider First Name:
OMAYRA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LND
Provider Gender Code:
F

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:
1194033001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6157
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:
00914-6157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-261-1169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JR1 CALLE LIZZIE GRAHAM
Provider Second Line Business Practice Location Address:
LEVITTOWN 7MA SEC
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949-3637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-261-1169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2010

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: 133V00000X , with the licence number:  1242 , 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)





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