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General NPI Number Information
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NPI Number | 1891182622
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Entity Type | Individual
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Provider Name | JONATHAN JIMENEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 1551 MARYLAND AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20002-7604
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Country | US
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Telephone | 202-396-1780
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Fax | 202-388-7568
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Provider Business Mailing Address
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Address Line | 12900 PARK PLAZA DR STE 150
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City | CERRITOS
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State | CA
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Zip | 90703-9329
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Country | US
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Telephone | 888-291-1358
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD046415
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License Number State | DC
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