MEDICARE: DR. GLORIA ANN JIMENEZ D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	20A10668	CA

General Provider Information

NPI Number	:	1396908869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA ANN JIMENEZ D.O.

Provider Business Mailing Address
First Line	:	555 CAPITOL MALL
Second Line	:	SUITE 260
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-4504
Country	:	US
Telephone Number	:	916-441-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 CAPITOL MALL
Second Line	:	SUITE 260
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-4504
Country	:	US
Telephone Number	:	916-441-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2008
Last Update Date	:	07/26/2013

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