Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | ME137760 | FL |
NPI | 1245594779 |
---|---|
Provider Name | Andres Jimenez Gomez |
First Address | Miramar, FL 33025-3925 |
Second Address | Miramar, FL 33029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103285700 | (05) | FL |