Healthcare Provider Details

I. General information

NPI: 1598129173
Provider Name (Legal Business Name): HUGO VLADIMIR JIMENEZ VAZQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. HUGO VLADIMIR JIMENEZ VAZQUEZ

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 S MILITARY TRL STE 944
WEST PALM BEACH FL
33415-3910
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 561-425-8000
  • Fax: 561-207-7882
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME183329
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number11-133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: