Provider Demographics
NPI:1336332717
Name:JIMENEZ, MARCELO ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:ANDRES
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 JFK DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6607
Mailing Address - Country:US
Mailing Address - Phone:561-434-0353
Mailing Address - Fax:561-357-0869
Practice Address - Street 1:180 JFK DR
Practice Address - Street 2:SUITE 311
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6607
Practice Address - Country:US
Practice Address - Phone:561-434-0353
Practice Address - Fax:561-357-0869
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
FLME112292207RC0001X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine