Healthcare Provider Details

I. General information

NPI: 1417085523
Provider Name (Legal Business Name): NORMA IVONNE JIMENEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 W 84TH ST SUITE 100
HIALEAH FL
33018-4933
US

IV. Provider business mailing address

3567 W 71ST TER
HIALEAH FL
33018-7105
US

V. Phone/Fax

Practice location:
  • Phone: 305-826-9449
  • Fax: 305-828-1255
Mailing address:
  • Phone: 786-200-4232
  • Fax: 305-394-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA9101494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: