Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 17995 | PR |
NPI | 1053562488 |
---|---|
Provider Name | Luis A Jimenez Reyes |
First Address | Villalba, PR 00766 |
Second Address | Caguas, PR 00725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2008 |
Last Update Date | 12/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17995 | LICENCIA (01) | PR |