=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174660005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HECTOR B JIMENEZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 02/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1321 NW 14TH ST STE 101
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-325-0913
-----------------------------------------------------
Fax | 305-326-8661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1321 NW 14TH ST STE 101
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-325-0913
-----------------------------------------------------
Fax | 305-326-8661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HECTOR B JIMENEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-325-0913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------