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NPI Code Detail

MEDICARE: MARIA JIMENEZ

MEDICARE: MARIA 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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
116487OTHERNYNYC SERVICE COORDINATION ID

General Provider Information

NPI Number : 1689935629
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA JIMENEZ
Provider Business Mailing Address
First Line : 369 E 148TH ST
Second Line : BASEMENT
City : BRONX
State : NY
Zip : 10455-4041
Country : US
Telephone Number : 718-269-2698
Fax Number : 718-292-0159
Provider Business Practice Location Address
First Line : 369 E 148TH ST
Second Line : BASEMENT
City : BRONX
State : NY
Zip : 10455-4041
Country : US
Telephone Number : 718-269-2698
Fax Number : 718-292-0159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2012
Last Update Date : 01/28/2013

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Directions to “ MARIA JIMENEZ ” Practice Location

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