MEDICARE: MR. GREGORIO JIMENEZ JR. FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95032728	CA
2	363LF0000X	Family Nurse Practitioner	95032728	CA

General Provider Information

NPI Number	:	1275355869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORIO JIMENEZ JR. FNP

Provider Business Mailing Address
First Line	:	4200 PECK RD STE B
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2177
Country	:	US
Telephone Number	:	626-350-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 PECK RD STE B
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2177
Country	:	US
Telephone Number	:	626-350-5073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2024
Last Update Date	:	07/08/2025

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