Basic Information
| Provider Information | |||||||||
| NPI: | 1457352890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIMENEZ | ||||||||
| FirstName: | RICKY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1047 CALLE CARITE | ||||||||
| Address2: | URB. VALLES DEL LAGO | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007257645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877470246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29 CALLE WASHINGTON | ||||||||
| Address2: | ASHFORD MEDICAL CENTER SUITE 202 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009071510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879775011 | ||||||||
| FaxNumber: | 7879775062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 02/16/2010 | ||||||||
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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 | 207RG0100X | 12272 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.