Provider Demographics
NPI:1154885564
Name:JIMENEZ GALARZA, WALESKA MILAGROS (MD)
Entity type:Individual
Prefix:
First Name:WALESKA
Middle Name:MILAGROS
Last Name:JIMENEZ GALARZA
Suffix:
Gender:F
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:HC 3 BOX 15245
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9859
Mailing Address - Country:US
Mailing Address - Phone:787-312-0936
Mailing Address - Fax:
Practice Address - Street 1:88 CALLE 5
Practice Address - Street 2:JACAGUAS SECTOR BAYOAN
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-312-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21215208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice