Provider Demographics
NPI:1164120952
Name:GARCIA JIMENEZ, JESUS MARIA
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MARIA
Last Name:GARCIA JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 CARLYLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4524
Mailing Address - Country:US
Mailing Address - Phone:561-308-2547
Mailing Address - Fax:
Practice Address - Street 1:863 CARLYLE AVE SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4524
Practice Address - Country:US
Practice Address - Phone:561-308-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist