Healthcare Provider Details

I. General information

NPI: 1295534980
Provider Name (Legal Business Name): JOSE ALBERTO JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAXON BLVD
ORANGE CITY FL
32763-8468
US

IV. Provider business mailing address

6797 CALISTOGA CIR
PORT ORANGE FL
32128-4033
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-5000
  • Fax:
Mailing address:
  • Phone: 407-575-2376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT17650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: