Healthcare Provider Details

I. General information

NPI: 1295970168
Provider Name (Legal Business Name): JOSEPH JIMENEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 G STREET SUITE 644
WASHINGTON DC
20001
US

IV. Provider business mailing address

13208 PALOMA DR
ORLANDO FL
32837-4796
US

V. Phone/Fax

Practice location:
  • Phone: 202-461-9678
  • Fax:
Mailing address:
  • Phone: 407-230-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberLS2362
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: