1336102920 NPI number — DR. OSVALDO JIMENEZ-MERCADO M.D.

Table of content: DR. BOAZ LEE BANDY D.C. (NPI 1265755227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336102920 NPI number — DR. OSVALDO JIMENEZ-MERCADO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ-MERCADO
Provider First Name:
OSVALDO
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
JIMENEZ
Provider Other First Name:
OSVALDO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336102920
Entity Type Code:
Individual
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:
110 CALLE GUARAGUAO
Provider Second Line Business Mailing Address:
URB. MONTEHIEDRA
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-720-3344
Provider Business Mailing Address Fax Number:
787-724-0561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SAN JUAN HEALTH CTR
Provider Second Line Business Practice Location Address:
SUITE 501 & 506 , DE DIEGO ST
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-2300
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:
04/06/2006

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: 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)





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