Provider Demographics
NPI:1588877211
Name:JIMENEZ-MONT, OLGA I
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:I
Last Name:JIMENEZ-MONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 26936
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9414
Mailing Address - Country:US
Mailing Address - Phone:787-306-3229
Mailing Address - Fax:
Practice Address - Street 1:BC7 CALLE 33
Practice Address - Street 2:REXVILLE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4144
Practice Address - Country:US
Practice Address - Phone:787-306-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR562261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0660622894OtherCIGNA
PR4141OtherAMERICAN HEALTH
PRP611OtherINT MEDICAL CARD
PR223230OtherPREFERRED HEALTH
PR223230OtherUTI
PR223230OtherPREFERRED HEALTH