MEDICARE: JESUS MARIA GARCIA JIMENEZ

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	225700000X	Massage Therapist	63531	FL

General Provider Information

NPI Number	:	1164120952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS MARIA GARCIA JIMENEZ

Provider Business Mailing Address
First Line	:	863 CARLYLE AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-4524
Country	:	US
Telephone Number	:	561-308-2547
Fax Number	:

Provider Business Practice Location Address
First Line	:	863 CARLYLE AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-4524
Country	:	US
Telephone Number	:	561-308-2547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/21/2023

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Directions to “ JESUS MARIA GARCIA JIMENEZ ” Practice Location

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