MEDICARE: JIMENEZ DIAZ SUPPORT SERVICES LLC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1326900242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMENEZ DIAZ SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	1111 COMMONWEALTH AVE APT 8TT
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-1038
Country	:	US
Telephone Number	:	347-364-0990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 COMMONWEALTH AVE APT 8TT
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-1038
Country	:	US
Telephone Number	:	347-364-0990
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARIA DIAZ DIAZ
Credential	:
Telephone Number	:	347-363-0990

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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