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General NPI Number Information
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NPI Number | 1629424460
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Entity Type | Individual
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Provider Name | ISMAEL JIMENEZ FNP
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Gender | Male
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 18533 SOLEDAD CANYON RD
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City | SANTA CLARITA
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State | CA
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Zip | 91351-3722
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Country | US
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Telephone | 661-673-8800
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Fax | 661-299-4023
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Provider Business Mailing Address
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Address Line | 29410 DAKOTAH CT
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-7101
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Country | US
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Telephone | 661-309-5216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95004241
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License Number State | CA
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