Healthcare Provider Details

I. General information

NPI: 1932686177
Provider Name (Legal Business Name): CAMILA OSPINA JIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

832 S CLAREMONT AVE UNIT 2C
CHICAGO IL
60612-4238
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 407-866-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301503913
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: