MEDICARE: MS. NORMA IVONNE JIMENEZ PA

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	208000000X	Pediatrics Physician	PA9101494	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417085523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NORMA IVONNE JIMENEZ PA

Provider Business Mailing Address
First Line	:	3567 W 71ST TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-7105
Country	:	US
Telephone Number	:	786-200-4232
Fax Number	:	305-394-6083

Provider Business Practice Location Address
First Line	:	3416 W 84TH ST
Second Line	:	SUITE 100
City	:	HIALEAH
State	:	FL
Zip	:	33018-4933
Country	:	US
Telephone Number	:	305-826-9449
Fax Number	:	305-828-1255

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	09/25/2011

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