Provider Demographics
NPI:1730482183
Name:JIMENEZ, ELIZABETH CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 W 9TH AVE APT 1000
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-2215
Mailing Address - Country:US
Mailing Address - Phone:508-410-4720
Mailing Address - Fax:
Practice Address - Street 1:2485 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6650
Practice Address - Country:US
Practice Address - Phone:805-364-0889
Practice Address - Fax:805-200-4434
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
D400090521OtherMEDICARE PTAN