MEDICARE: DR. ANDRES L JIMENEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME22390	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14742	OTHER	NE	LICENSE
2	ME22390	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1184834525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRES L JIMENEZ M.D.

Provider Business Mailing Address
First Line	:	1217 GRANADA BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2411
Country	:	US
Telephone Number	:	786-412-2584
Fax Number	:	305-445-3838

Provider Business Practice Location Address
First Line	:	1320 S DIXIE HWY
Second Line	:	SUITE 400
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2926
Country	:	US
Telephone Number	:	305-243-7780
Fax Number	:	305-243-7790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/07/2023

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