Basic Information
| Provider Information | |||||||||
| NPI: | 1053562488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIMENEZ REYES | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | A26 CALLE 1 | ||||||||
| Address2: | URB LAS ALONDRAS | ||||||||
| City: | VILLALBA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873715559 | ||||||||
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| Practice Location | |||||||||
| Address1: | 172 URB TURABO GARDENS | ||||||||
| Address2: | CARR | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879204090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2008 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 17995 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 17995 | 01 | PR | LICENCIA | OTHER |