Basic Information
| Provider Information | |||||||||
| NPI: | 1184819773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIMENEZ-PEREZ | ||||||||
| FirstName: | EDIL | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 261 DORADO BCH E | ||||||||
| Address2: | |||||||||
| City: | DORADO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006462212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874753747 | ||||||||
| FaxNumber: | 7878541452 | ||||||||
| Practice Location | |||||||||
| Address1: | BAYAMON MEDICAL PLAZA STE 701 | ||||||||
| Address2: | CARR #2 KM 11.7 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009590001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877985500 | ||||||||
| FaxNumber: | 7877872101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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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 | 207X00000X | 0101252032 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 18438 | PR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.