Provider Demographics
NPI:1932073582
Name:JIMENEZ DE VIVIECA, LEIDYS MIRIANNY (SA-C)
Entity type:Individual
Prefix:
First Name:LEIDYS
Middle Name:MIRIANNY
Last Name:JIMENEZ DE VIVIECA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9175 SW 63RD CT
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1854
Mailing Address - Country:US
Mailing Address - Phone:786-681-3548
Mailing Address - Fax:
Practice Address - Street 1:9175 SW 63RD CT
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1854
Practice Address - Country:US
Practice Address - Phone:786-681-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-424246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant