Basic Information
| Provider Information | |||||||||
| NPI: | 1013012566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENEZ | ||||||||
| FirstName: | ANGELICA | ||||||||
| MiddleName: | ROCIO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 NE 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331372706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057518626 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1150 N 35TH AVE | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330215424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542656989 | ||||||||
| FaxNumber: | 9549653599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A93472 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | ME95805 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207QG0300X | ME95805 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2773210-00 | 05 | FL | MEDICAID |