Provider Demographics
NPI:1053430868
Name:OSVALDO JIMENEZ,M.D.,PSC.
Entity type:Organization
Organization Name:OSVALDO JIMENEZ,M.D.,PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-724-0550
Mailing Address - Street 1:PO BOX 364807
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4807
Mailing Address - Country:US
Mailing Address - Phone:787-724-0550
Mailing Address - Fax:
Practice Address - Street 1:150 CALLE DE DIEGO
Practice Address - Street 2:SUITE 501
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3406
Practice Address - Country:US
Practice Address - Phone:787-724-0550
Practice Address - Fax:787-724-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6072207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-26684Medicare UPIN
PR0097959Medicare PIN