=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700521671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA JIMENEZ PAZ PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2022
-----------------------------------------------------
Last Update Date | 05/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1380 NE MIAMI GARDENS DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33179-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-956-7755
-----------------------------------------------------
Fax | 786-446-7271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15051 ROYAL OAKS LN APT 306
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-351-9639
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9114127
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------