Provider Demographics
NPI:1649421058
Name:HERA JIMENEZ, ALEIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEIDA
Middle Name:
Last Name:HERA JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 SW 74TH ST
Mailing Address - Street 2:APT 2301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4001
Mailing Address - Country:US
Mailing Address - Phone:561-271-8441
Mailing Address - Fax:
Practice Address - Street 1:700 SW 8TH ST
Practice Address - Street 2:825 SW 87TH AVENUE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3311
Practice Address - Country:US
Practice Address - Phone:305-264-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17334208D00000X
FLACN328208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002051800Medicaid