Healthcare Provider Details

I. General information

NPI: 1003975509
Provider Name (Legal Business Name): JESUS GIL JIMENEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-4110
  • Fax:
Mailing address:
  • Phone: 925-295-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME84808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: