Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 63795 | CT |
NPI | 1174943369 |
---|---|
Provider Name | Andrew Jimenez |
First Address | New Haven, CT 06510-3209 |
Second Address | New Haven, CT 06510-3209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2014 |
Last Update Date | 09/09/2021 |