Provider Demographics
NPI:1124366000
Name:JIMENEZ, BLANCA XIMENA (RD)
Entity Type:Individual
Prefix:MISS
First Name:BLANCA
Middle Name:XIMENA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 SW 88TH ST
Mailing Address - Street 2:H402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8019
Mailing Address - Country:US
Mailing Address - Phone:786-346-6799
Mailing Address - Fax:
Practice Address - Street 1:615 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6213
Practice Address - Country:US
Practice Address - Phone:305-535-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3557133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered