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General NPI Number Information
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NPI Number | 1790927176
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Entity Type | Individual
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Provider Name | OTONIEL JIMENEZ AFRNP
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Gender | Male
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 2148 HACIENDA TER
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City | WESTON
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State | FL
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Zip | 33327-2237
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Country | US
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Telephone | 754-244-2954
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Fax | 954-306-0455
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Provider Business Mailing Address
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Address Line | 4363 MAGNOLIA RIDGE DR
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City | WESTON
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State | FL
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Zip | 33331-5009
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Country | US
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Telephone | 754-244-2954
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 07-265
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 9489531
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License Number State | FL
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