MEDICARE: ULYSSES ROMMEL JIMENEZ DPT

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	225100000X	Physical Therapist	300742	CA

General Provider Information

NPI Number	:	1477217966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ULYSSES ROMMEL JIMENEZ DPT

Provider Business Mailing Address
First Line	:	6586 AMBROSIA DR APT 5204
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-3140
Country	:	US
Telephone Number	:	408-830-6691
Fax Number	:

Provider Business Practice Location Address
First Line	:	3191 SPORTS ARENA BLVD STE B
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4569
Country	:	US
Telephone Number	:	619-226-4131
Fax Number	:

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

Provider Enumeration Date	:	10/29/2021
Last Update Date	:	10/29/2021

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