Healthcare Provider Details

I. General information

NPI: 1326900242
Provider Name (Legal Business Name): JIMENEZ DIAZ SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 COMMONWEALTH AVE APT 8TT
BRONX NY
10472-1038
US

IV. Provider business mailing address

1111 COMMONWEALTH AVE APT 8TT
BRONX NY
10472-1038
US

V. Phone/Fax

Practice location:
  • Phone: 347-364-0990
  • Fax:
Mailing address:
  • Phone: 347-364-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIA DIAZ DIAZ
Title or Position: CEO
Credential:
Phone: 347-363-0990