Provider Demographics
NPI:1316054646
Name:JIMENEZ BARRERAS, RAFAEL JENARO (DMD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:JENARO
Last Name:JIMENEZ BARRERAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1793
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1793
Mailing Address - Country:US
Mailing Address - Phone:787-733-2431
Mailing Address - Fax:787-733-2431
Practice Address - Street 1:CALLE JOSE C BARBOSA #56
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-1793
Practice Address - Country:US
Practice Address - Phone:787-733-2431
Practice Address - Fax:787-733-2431
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist