Provider Demographics
NPI:1447700034
Name:F JIMENEZ MEDICAL CORPORATION
Entity type:Organization
Organization Name:F JIMENEZ MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JIMENEZ
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:A
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-357-1944
Mailing Address - Street 1:360 E 7TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6701
Mailing Address - Country:US
Mailing Address - Phone:909-920-9193
Mailing Address - Fax:909-920-6019
Practice Address - Street 1:360 E 7TH ST STE D
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6701
Practice Address - Country:US
Practice Address - Phone:909-920-9193
Practice Address - Fax:909-920-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A403050Medicaid
CA00A403050Medicaid