Individual
DR. IVELISSE PENA JIMENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
346 CALLE 32, VILLA NEVAREZ, SAN JUAN, PR 00927-5111
(787) 751-2653
Mailing address
PO BOX 51320, TOA BAJA, PR 00950-1320
(787) 751-2653
(787) 753-4807
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12440
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20041
TRIPLE S
PR
01
—
2499
PMC
PR
01
—
500475E
MMM
PR
01
—
5234
FIRST MEDICAL
PR
01
—
9270157
HUMANA
PR
Enumeration date
01/30/2007
Last updated
07/09/2007
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