Provider Demographics
NPI:1174660005
Name:HECTOR B JIMENEZ MD PA
Entity Type:Organization
Organization Name:HECTOR B JIMENEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:B
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-325-0913
Mailing Address - Street 1:1321 NW 14TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1653
Mailing Address - Country:US
Mailing Address - Phone:305-325-0913
Mailing Address - Fax:305-326-8661
Practice Address - Street 1:1321 NW 14TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1653
Practice Address - Country:US
Practice Address - Phone:305-325-0913
Practice Address - Fax:305-326-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068354000OtherMEDICAID
FL233662OtherAVMED
FL233662OtherAVMED