MEDICARE: MITZI T JIMINEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	F6790	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134161615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITZI T JIMINEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 231233
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77223-1233
Country	:	US
Telephone Number	:	713-923-6333
Fax Number	:	713-923-4197

Provider Business Practice Location Address
First Line	:	910 S WAYSIDE DR
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77023-3428
Country	:	US
Telephone Number	:	713-923-6333
Fax Number	:	713-923-4197

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MITZI T. JIMENEZ
Credential	:	M.D.
Telephone Number	:	713-923-6333

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2009

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