MEDICARE: JANICE JIMENEZ RDH

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	124Q00000X	Dental Hygienist	27683	CA

General Provider Information

NPI Number	:	1962915157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE JIMENEZ RDH

Provider Business Mailing Address
First Line	:	1275 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-3476
Country	:	US
Telephone Number	:	619-662-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 E 8TH ST
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2312
Country	:	US
Telephone Number	:	619-662-4100
Fax Number	:

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

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/09/2017

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