Provider Demographics
NPI:1871513754
Name:CARRILLO JIMENEZ, RODOLFO (MD)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:CARRILLO JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 LINTON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6537
Mailing Address - Country:US
Mailing Address - Phone:561-496-7900
Mailing Address - Fax:877-536-5811
Practice Address - Street 1:5210 LINTON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6537
Practice Address - Country:US
Practice Address - Phone:561-496-7900
Practice Address - Fax:615-365-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82672174400000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH27015Medicare UPIN
FL13869WMedicare PIN