1336325232 NPI number — VIRGINIA CECILE DUANY JIMENEZ DO

Table of content: VIRGINIA CECILE DUANY JIMENEZ DO (NPI 1336325232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336325232 NPI number — VIRGINIA CECILE DUANY JIMENEZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUANY JIMENEZ
Provider First Name:
VIRGINIA
Provider Middle Name:
CECILE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUANY
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336325232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3975 ROBINSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28658-9715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-466-0466
Provider Business Mailing Address Fax Number:
828-466-8862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3975 ROBINSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-466-0466
Provider Business Practice Location Address Fax Number:
828-466-8862
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  200701878 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QH0002X , with the licence number: 2007-01878 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 148G7 . This is a "NC BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5908876 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2007-01878 . This is a "LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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