=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790701514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LATINO HEALTH SERVICES MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 N MAIN ST STE 100
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-4684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-647-0401
-----------------------------------------------------
Fax | 714-647-9465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 N MAIN ST STE 100
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92701-4684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-647-0401
-----------------------------------------------------
Fax | 714-647-9465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | FRANCISCO A JIMENEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-647-0401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------