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General NPI Number Information
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NPI Number | 1689873523
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Entity Type | Individual
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Provider Name | FERNANDO JOSE JIMENEZ D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 5139 LITTLE RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34655-1212
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Country | US
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Telephone | 813-336-8478
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Fax |
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Provider Business Mailing Address
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Address Line | 143-3 CALLE 401 VILLA CAROLINA
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City | CAROLINA
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State | PR
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Zip | 00985-4022
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Country | US
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Telephone | 787-200-5542
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Fax | 787-200-5543
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2769
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN 19685
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License Number State | FL
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