Provider Demographics
NPI:1801434436
Name:JIMENEZ, SANTIAGO
Entity type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 PALM BEACH LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2203
Mailing Address - Country:US
Mailing Address - Phone:561-612-6000
Mailing Address - Fax:
Practice Address - Street 1:1655 PALM BEACH LAKES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2203
Practice Address - Country:US
Practice Address - Phone:561-612-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105072800Medicaid