Provider Demographics
NPI:1477714533
Name:RODOLFO CARRILLO JIMENEZ MD PA
Entity Type:Organization
Organization Name:RODOLFO CARRILLO JIMENEZ MD PA
Other - Org Name:FLORIDA PREMIER CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-496-7900
Mailing Address - Street 1:5210 LINTON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6537
Mailing Address - Country:US
Mailing Address - Phone:561-496-7900
Mailing Address - Fax:775-365-8118
Practice Address - Street 1:5210 LINTON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6537
Practice Address - Country:US
Practice Address - Phone:561-496-7900
Practice Address - Fax:877-536-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-21
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264560200Medicaid
FLH27015Medicare UPIN
FLAV116AMedicare PIN