Provider Demographics
NPI:1225353766
Name:JIMENEZ, MARIO ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ALBERTO
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 NW 36TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2499
Mailing Address - Country:US
Mailing Address - Phone:305-262-1610
Mailing Address - Fax:
Practice Address - Street 1:7200 NW 7TH ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2941
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:305-266-9939
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME114414208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022441000Medicaid
FLME114414OtherMEDICAL DOCTOR