Healthcare Provider Details

I. General information

NPI: 1790996387
Provider Name (Legal Business Name): LUIS C JIMENEZ RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14843 SW 173RD TER
MIAMI FL
33187-6701
US

IV. Provider business mailing address

14843 SW 173RD TER
MIAMI FL
33187-6701
US

V. Phone/Fax

Practice location:
  • Phone: 305-978-2507
  • Fax:
Mailing address:
  • Phone: 305-978-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number3892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: