Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A93472 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME95805 | FL |
NPI | 1013012566 |
---|---|
Provider Name | Angelica Rocio Jimenez |
First Address | Miami, FL 33137-2706 |
Second Address | Hollywood, FL 33021-5424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2773210-00 | (05) | FL |