Healthcare Provider Details

I. General information

NPI: 1437841129
Provider Name (Legal Business Name): GUILLERMO JIMENEZ PA-C PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 SW 72ND ST STE 241
MIAMI FL
33173-3265
US

IV. Provider business mailing address

10810 SW 126TH AVE
MIAMI FL
33186-3749
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMO J JIMENEZ
Title or Position: OWNER
Credential: PA
Phone: 786-423-3357