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John Jimenez-Agosto

Pediatrics

Allopathic & Osteopathic Physicians

59 Calle Santa Cruz, Fourth Floor, Bayamon, PR 00961-6900

PECOS Enrollment

Based on the most recent information from CMS, provider John Jimenez-Agosto does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records today at 10:51 AM.

Profile Details

Provider ID
1376533034
Provider Type
Individual
Full Name
Jimenez-Agosto, John
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
10/25/2005
Last Updated
5/28/2009

Contact Information

Practice Location

59 Calle Santa Cruz, Fourth Floor, Bayamon, PR 00961-6900

(787) 717-6240

Unlisted Fax

Mailing Location

C/ Limoncillo #73, Santa Maria, San Juan, PR 00927-6622

(787) 717-6240

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208000000X Primary	Description Pediatrics Allopathic & Osteopathic Physicians	License 5724 Puerto Rico

Provider Identifiers

ID	Description	Issuer
ID 5724	Description Other	Issuer NAT LICENSE

John Jimenez-Agosto

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Bosch-Gonsalvez, Enrique Francisco

Lebron Gonzalez, Carmen Mabel

Lecumberry, Maria Antonia

Rosario, Karla M

Torres Suarez, Luis Angel

Cotto, Carmen Waleska

Suarez, Carmen I

Ponce Paredes, Guillermo

Miranda, William

Ruiz, Maria Del C.