MEDICARE: JIMENEZ DE PENA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	HCC4399	FL

General Provider Information

NPI Number	:	1104803311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMENEZ DE PENA INC

Provider Business Mailing Address
First Line	:	8360 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4180
Country	:	US
Telephone Number	:	305-267-6165
Fax Number	:	305-267-6156

Provider Business Practice Location Address
First Line	:	8360 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4180
Country	:	US
Telephone Number	:	305-267-6165
Fax Number	:	305-267-6156

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAUL BOZA
Credential	:
Telephone Number	:	305-281-6066

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	08/08/2007

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Directions to “JIMENEZ DE PENA INC ” Practice Location

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