Provider Demographics
NPI:1184834525
Name:JIMENEZ, ANDRES L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:L
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1217 GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2411
Mailing Address - Country:US
Mailing Address - Phone:786-412-2584
Mailing Address - Fax:305-445-3838
Practice Address - Street 1:1320 S DIXIE HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2926
Practice Address - Country:US
Practice Address - Phone:305-243-7780
Practice Address - Fax:305-243-7790
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME223902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE14742OtherLICENSE
FLME22390OtherLICENSE NUMBER
FLME22390OtherLICENSE NUMBER
D59997Medicare UPIN
92232Medicare ID - Type Unspecified