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General NPI Number Information
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NPI Number | 1720320542
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Entity Type | Organization
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Legal Business Name | MICHAEL ANGEL JIMENEZ, MD, INC.
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 3628 E IMPERIAL HWY SUITE 401
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City | LYNWOOD
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State | CA
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Zip | 90262-2643
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Country | US
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Telephone | 424-213-4290
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Fax | 424-213-4290
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Provider Business Mailing Address
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Address Line | 3628 E IMPERIAL HWY SUITE 401
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City | LYNWOOD
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State | CA
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Zip | 90262-2643
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Country | US
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Telephone | 424-213-4290
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Fax | 424-213-4290
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL ANGEL JIMENEZ
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Credential | M.D.
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Telephone | 424-213-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A120714
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | A120714
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | A120714
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License Number State | CA
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