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NPI Code Detail

MEDICARE: MARIA ESTELA JIMENEZ D.A.

MEDICARE: MARIA ESTELA JIMENEZ D.A.
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
1126800000XDental AssistantC0102976CA

General Provider Information

NPI Number : 1831335025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA ESTELA JIMENEZ D.A.
Provider Business Mailing Address
First Line : 12121 WILSHIRE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-1123
Country : US
Telephone Number : 131-082-0993
Fax Number : 131-082-0040
Provider Business Practice Location Address
First Line : 12121 WILSHIRE BLVD
Second Line : SUITE 1111
City : LOS ANGELES
State : CA
Zip : 90025-1123
Country : US
Telephone Number : 131-082-0993
Fax Number : 131-082-0040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2008
Last Update Date : 12/18/2008

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