Healthcare Provider Details

I. General information

NPI: 1609447655
Provider Name (Legal Business Name): MASSIEL JIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRL STE 301
RIVERSIDE RI
02915-2235
US

IV. Provider business mailing address

2 DUDLEY ST, MOC BUILDING SUITE 370
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4050
  • Fax:
Mailing address:
  • Phone: 401-444-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: