Healthcare Provider Details

I. General information

NPI: 1700521671
Provider Name (Legal Business Name): VANESSA JIMENEZ PAZ PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR
MIAMI FL
33179-4707
US

IV. Provider business mailing address

15051 ROYAL OAKS LN APT 306
NORTH MIAMI FL
33181-2458
US

V. Phone/Fax

Practice location:
  • Phone: 305-956-7755
  • Fax: 786-446-7271
Mailing address:
  • Phone: 786-351-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: