Provider Demographics
NPI:1073280228
Name:DIAZ JIMENEZ, CLAUDIA CAROLINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:CAROLINA
Last Name:DIAZ JIMENEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S EUTAW ST APT 1414
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1692
Mailing Address - Country:US
Mailing Address - Phone:432-230-1181
Mailing Address - Fax:
Practice Address - Street 1:11 S EUTAW ST APT 1414
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1692
Practice Address - Country:US
Practice Address - Phone:432-230-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014176651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice