Healthcare Provider Details

I. General information

NPI: 1396587127
Provider Name (Legal Business Name): KYRA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 NW 107TH AVE STE 100
DORAL FL
33172-2215
US

IV. Provider business mailing address

185 SW 7TH ST APT 3805
MIAMI FL
33130-2985
US

V. Phone/Fax

Practice location:
  • Phone: 786-388-0950
  • Fax:
Mailing address:
  • Phone: 305-498-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN2047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: