Healthcare Provider Details

I. General information

NPI: 1215062393
Provider Name (Legal Business Name): JESUS LINO JIMENEZ BARREDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W 64TH ST
HIALEAH FL
33016-2607
US

IV. Provider business mailing address

11501 SW 40TH ST
MIAMI FL
33165-3313
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-5366
  • Fax: 305-631-3828
Mailing address:
  • Phone: 305-642-5366
  • Fax: 305-631-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME101359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: