Provider Demographics
NPI:1316680119
Name:JIMENEZ CORADO, DANIEL RICARDO (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RICARDO
Last Name:JIMENEZ CORADO
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 1:24 HOSPITAL AVENUE,
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-739-8105
Mailing Address - Fax:203-749-9092
Practice Address - Street 1:24 HOSPITAL AVENUE,
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-739-8105
Practice Address - Fax:203-749-9092
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2023-04-26
Deactivation Date:2023-01-13
Deactivation Code:
Reactivation Date:2023-04-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program