Healthcare Provider Details

I. General information

NPI: 1114849486
Provider Name (Legal Business Name): XAVIER F JIMENEZ RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26485 PRAIRIE LN
MORENO VALLEY CA
92555-2951
US

IV. Provider business mailing address

26485 PRAIRIE LN
MORENO VALLEY CA
92555-2951
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 909-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number763619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: