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NPI Code Detail

MEDICARE: MR. JAN JIMENEZ DO

MEDICARE: MR. JAN JIMENEZ DO
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1720928914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAN JIMENEZ DO
Provider Business Mailing Address
First Line : 1701 W CHARLESTON BLVD STE 670
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2343
Country : US
Telephone Number : 702-780-7588
Fax Number : 702-671-2233
Provider Business Practice Location Address
First Line : 1701 W CHARLESTON BLVD STE 670
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2343
Country : US
Telephone Number : 702-780-7588
Fax Number : 702-671-2233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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