Healthcare Provider Details

I. General information

NPI: 1487357281
Provider Name (Legal Business Name): JOSE LUIS JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1125
US

IV. Provider business mailing address

6451 S REED BUNTING DR
TUCSON AZ
85757-7944
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5970
  • Fax:
Mailing address:
  • Phone: 623-340-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA210301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: