Healthcare Provider Details

I. General information

NPI: 1841817194
Provider Name (Legal Business Name): JUAN GABRIEL JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST BLDG 500
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

11200 SW 8TH ST # 4-274
MIAMI FL
33199-2516
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-5250
  • Fax:
Mailing address:
  • Phone: 305-348-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35703
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number104814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: