Provider Demographics
NPI:1497789317
Name:JIMENEZ DE CARDENAS, JOAQUIN M (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:M
Last Name:JIMENEZ DE CARDENAS
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 1:358 SAN LORENZO AVE
Mailing Address - Street 2:SUITE 3230
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-444-6882
Mailing Address - Fax:305-441-9110
Practice Address - Street 1:358 SAN LORENZO AVE
Practice Address - Street 2:SUITE 3230
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146
Practice Address - Country:US
Practice Address - Phone:305-444-6882
Practice Address - Fax:305-441-9110
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME75373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74707Medicare UPIN