Provider Demographics
NPI:1730148750
Name:MENDEZ JIMINIAN, JOSE M (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:MENDEZ JIMINIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE GENERAL VALERO # 353
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3949
Mailing Address - Country:US
Mailing Address - Phone:787-863-4714
Mailing Address - Fax:787-863-4714
Practice Address - Street 1:AVE GENERAL VALERO # 353
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3949
Practice Address - Country:US
Practice Address - Phone:787-863-4714
Practice Address - Fax:787-863-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12631208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH81709Medicare UPIN
PR0080583Medicare ID - Type Unspecified