Provider Demographics
NPI:1215062393
Name:JIMENEZ BARREDO, JESUS LINO (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:LINO
Last Name:JIMENEZ BARREDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3313
Mailing Address - Country:US
Mailing Address - Phone:305-642-5366
Mailing Address - Fax:305-631-3828
Practice Address - Street 1:2020 W 64TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2607
Practice Address - Country:US
Practice Address - Phone:305-642-5366
Practice Address - Fax:305-631-3828
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine