Healthcare Provider Details

I. General information

NPI: 1811908502
Provider Name (Legal Business Name): JOSE RAFAEL JIMENEZ-GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 N ALAFAYA TRL UNIT 3
ORLANDO FL
32826-4716
US

IV. Provider business mailing address

425 W COLONIAL DR
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-627-0062
  • Fax: 407-674-7346
Mailing address:
  • Phone: 321-343-6833
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12658
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: