Healthcare Provider Details

I. General information

NPI: 1285560482
Provider Name (Legal Business Name): PEDRO LUIS JIMENEZ GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

1400 NW 10TH AVE APT 1710
MIAMI FL
33136-1035
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2310
  • Fax:
Mailing address:
  • Phone: 305-479-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN46391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: