Healthcare Provider Details

I. General information

NPI: 1831335025
Provider Name (Legal Business Name): MARIA ESTELA JIMENEZ D.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 WILSHIRE BLVD SUITE 1111
LOS ANGELES CA
90025-1123
US

IV. Provider business mailing address

12121 WILSHIRE BLVD
LOS ANGELES CA
90025-1123
US

V. Phone/Fax

Practice location:
  • Phone: 131-082-0993
  • Fax: 131-082-0040
Mailing address:
  • Phone: 131-082-0993
  • Fax: 131-082-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberC0102976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: