Provider Demographics
NPI:1598129173
Name:JIMENEZ VAZQUEZ, HUGO VLADIMIR (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:VLADIMIR
Last Name:JIMENEZ VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HUGO
Other - Middle Name:VLADIMIR
Other - Last Name:JIMENEZ VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14860 ENCLAVE PRESERVE CIR APT 8T3
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8826
Mailing Address - Country:US
Mailing Address - Phone:786-521-8206
Mailing Address - Fax:
Practice Address - Street 1:2994 S JOG RD STE A
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-2000
Practice Address - Country:US
Practice Address - Phone:561-433-8900
Practice Address - Fax:888-815-1749
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1412208D00000X
FL11-133246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant