1922069954 NPI number — DR. ANGEL R CANCEL-JIMENEZ MD

Table of content: DR. ANGEL R CANCEL-JIMENEZ MD (NPI 1922069954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922069954 NPI number — DR. ANGEL R CANCEL-JIMENEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANCEL-JIMENEZ
Provider First Name:
ANGEL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANCEL
Provider Other First Name:
ANGEL
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922069954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 HARRISON PKWY
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-437-2672
Provider Business Mailing Address Fax Number:
954-616-3591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W OAK ST
Provider Second Line Business Practice Location Address:
DEPT OF ANESTHESIA
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-846-2266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2006

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: 207L00000X , with the licence number:  ME106141 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 148VN . This is a "BLUE CROSS BLUE SHIELD FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002349000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015306300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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