Provider Demographics
NPI:1336510718
Name:JIMENEZ, DIANA (OD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 NW 107TH AVE
Mailing Address - Street 2:SUITE 790
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1455 NW 107TH AVE
Practice Address - Street 2:SUITE 790
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2711
Practice Address - Country:US
Practice Address - Phone:786-224-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist