Healthcare Provider Details

I. General information

NPI: 1497844401
Provider Name (Legal Business Name): EVA JIMENEZ FELICIANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/02/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

12223 HIGHLAND AVE SUITE #535
RANCHO CUCAMONGA CA
91739-2574
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-9000
  • Fax:
Mailing address:
  • Phone: 909-899-5567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA68287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: