Provider Demographics
NPI:1073805610
Name:JIMENEZ, ALFREDO (LMT)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 SW 61ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1206
Mailing Address - Country:US
Mailing Address - Phone:786-443-7374
Mailing Address - Fax:
Practice Address - Street 1:10770 SW 61ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1206
Practice Address - Country:US
Practice Address - Phone:786-443-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63189261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation