MEDICARE: VIVIANA JIMENEZ RN

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	163W00000X	Registered Nurse	614810	NY

General Provider Information

NPI Number	:	1528379542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA JIMENEZ RN

Provider Business Mailing Address
First Line	:	2125 RANDALL AVE
Second Line	:	APT-5F
City	:	BRONX
State	:	NY
Zip	:	10473-1747
Country	:	US
Telephone Number	:	718-671-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 RANDALL AVE
Second Line	:	APT-5F
City	:	BRONX
State	:	NY
Zip	:	10473-1747
Country	:	US
Telephone Number	:	718-671-2100
Fax Number	:

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

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	06/24/2010

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