Provider Demographics
NPI:1982783353
Name:JIMENEZ, MAURIN (MD)
Entity type:Individual
Prefix:DR
First Name:MAURIN
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4271
Mailing Address - Country:US
Mailing Address - Phone:786-619-3360
Mailing Address - Fax:786-619-3360
Practice Address - Street 1:962 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4271
Practice Address - Country:US
Practice Address - Phone:786-619-3360
Practice Address - Fax:786-619-3360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95052207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108944400Medicaid