Healthcare Provider Details

I. General information

NPI: 1255249108
Provider Name (Legal Business Name): ROSMERY DEL SOCORRO MARTINEZ JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 E MAIN ST STE 8
SAN JACINTO CA
92583-4200
US

IV. Provider business mailing address

166 E MAIN ST STE 8
SAN JACINTO CA
92583-4200
US

V. Phone/Fax

Practice location:
  • Phone: 951-292-8762
  • Fax: 951-364-3767
Mailing address:
  • Phone: 951-292-8762
  • Fax: 951-364-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberBL-005435-2026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: