Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 18508 | PR |
NPI | 1073746392 |
---|---|
Provider Name | Ruth Mareva Fred Jimenez |
First Address | Rio Grande, PR 00745-0756 |
Second Address | Rio Grande, PR 00745-3063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2009 |
Last Update Date | 30/07/2015 |