Provider Demographics
NPI:1134547755
Name:JIMENEZ, CARMEN (DOM, AP)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 82ND AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1835
Mailing Address - Country:US
Mailing Address - Phone:954-284-0322
Mailing Address - Fax:954-281-5927
Practice Address - Street 1:100 NW 82ND AVE STE 304
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1835
Practice Address - Country:US
Practice Address - Phone:954-284-0322
Practice Address - Fax:954-281-5927
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001191171100000X
FL3492171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist