Provider Demographics
NPI:1417085523
Name:JIMENEZ, NORMA IVONNE (PA)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:IVONNE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3567 W 71ST TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7105
Mailing Address - Country:US
Mailing Address - Phone:786-200-4232
Mailing Address - Fax:305-394-6083
Practice Address - Street 1:3416 W 84TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4933
Practice Address - Country:US
Practice Address - Phone:305-826-9449
Practice Address - Fax:305-828-1255
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291822600Medicaid