Healthcare Provider Details

I. General information

NPI: 1669969192
Provider Name (Legal Business Name): ARTURO CONTRERAS JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 YOUNGERMAN CT STE 104
JACKSONVILLE FL
32244-6692
US

IV. Provider business mailing address

8725 YOUNGERMAN CT STE 104
JACKSONVILLE FL
32244-6692
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-4751
  • Fax:
Mailing address:
  • Phone: 305-202-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: