Basic Information
| Provider Information | |||||||||
| NPI: | 1295787927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENEZ CARCAMO | ||||||||
| FirstName: | FRANCISCO | ||||||||
| MiddleName: | JAVIER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JIMENEZ | ||||||||
| OtherFirstName: | JAVIER | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6200 SUNSET DR | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056664633 | ||||||||
| FaxNumber: | 3056625754 | ||||||||
| Practice Location | |||||||||
| Address1: | 6200 SUNSET DR | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056664633 | ||||||||
| FaxNumber: | 3056625754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 02/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME0082470 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 261806100 | 05 | FL | MEDICAID |