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4019 W Waters Ave Ste B Tampa FL 33614-1949 | |
| (813) 582-7000 | |
| (813) 392-2165 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4019 W Waters Ave Ste B, Tampa, Florida |
| Authorized Official Name and Position | Lianny Jimenez (OWNER) |
| Authorized Official Contact | 8133922164 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4019 W Waters Ave Ste B Tampa FL 33614-1949 Ph: (813) 582-7000 | 4019 W Waters Ave Ste B Tampa FL 33614-1949 Ph: (813) 582-7000 |
| NPI Number | 1962086777 |
|---|---|
| Provider Enumeration Date | 05/07/2021 |
| Last Update Date | 05/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962086777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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