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General NPI Number Information
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NPI Number | 1255618112
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Entity Type | Organization
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Legal Business Name | MITZI T. JIMENEZ MD PA
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 910 S WAYSIDE DR STE 150
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City | HOUSTON
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State | TX
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Zip | 77023-3430
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Country | US
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Telephone | 713-923-6333
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Fax | 713-923-4197
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Provider Business Mailing Address
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Address Line | PO BOX 231233
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City | HOUSTON
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State | TX
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Zip | 77223-1233
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Country | US
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Telephone | 713-923-6333
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Fax | 713-923-4197
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MITZI T JIMENEZ
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Credential | MD
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Telephone | 713-923-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F-6790
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License Number State | TX
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