Provider Demographics
NPI:1730164351
Name:MARTIN - JIMENEZ, MILAGROS B (MD)
Entity type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:B
Last Name:MARTIN - JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MILAGROS
Other - Middle Name:
Other - Last Name:MARTIN - DE PUMAREJO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PARQUES DE SAN IGNACIO
Mailing Address - Street 2:ST.1 C5
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:787-764-0022
Practice Address - Street 1:382 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3719
Practice Address - Country:US
Practice Address - Phone:787-758-1122
Practice Address - Fax:787-758-1122
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6301208000000X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics