Provider Demographics
NPI:1073813945
Name:STEVEN JIMENEZ M.D. INC.
Entity Type:Organization
Organization Name:STEVEN JIMENEZ M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER, TREASURER,SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-367-0323
Mailing Address - Street 1:4974 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1400
Mailing Address - Country:US
Mailing Address - Phone:702-367-0323
Mailing Address - Fax:702-367-4431
Practice Address - Street 1:4974 S RAINBOW BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1400
Practice Address - Country:US
Practice Address - Phone:702-367-0323
Practice Address - Fax:702-367-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NV8183261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2002755Medicaid