MEDICARE: MISS IRENE - JIMENEZ RN,PHN

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	163WC1500X	Community Health Registered Nurse	288830	CA

General Provider Information

NPI Number	:	1417017971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS IRENE - JIMENEZ RN,PHN

Provider Business Mailing Address
First Line	:	8708 PACIFIC HILLS WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95828-5123
Country	:	US
Telephone Number	:	916-689-2056
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 BECK AVE
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6804
Country	:	US
Telephone Number	:	707-784-8650
Fax Number	:	707-421-7484

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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