Healthcare Provider Details

I. General information

NPI: 1023360807
Provider Name (Legal Business Name): F JIMENEZ MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N 2ND AVE
UPLAND CA
91786-8325
US

IV. Provider business mailing address

308 N 2ND AVE
UPLAND CA
91786-8325
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-9193
  • Fax: 909-920-6019
Mailing address:
  • Phone: 909-920-9193
  • Fax: 909-920-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40305
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA40305
License Number StateCA

VIII. Authorized Official

Name: DR. FRANCISCO JIMENEZ
Title or Position: CEO
Credential: M.D.
Phone: 909-920-9193