Provider Demographics
NPI:1568089621
Name:VILLAVICENCIO JIMENEZ, MARIA FERNANDA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:VILLAVICENCIO JIMENEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL MSC 8116-0043-14
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-2094
Mailing Address - Fax:314-454-2515
Practice Address - Street 1:1 CHILDRENS PL MSC 8116-0043-14
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2094
Practice Address - Fax:314-454-2515
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-03-27
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Provider Licenses
StateLicense IDTaxonomies
KS94-10379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics