Provider Demographics
NPI:1114099942
Name:JIMENEZ, CESAR A (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:A
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N ORANGE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2032
Mailing Address - Country:US
Mailing Address - Phone:626-964-0099
Mailing Address - Fax:626-964-2209
Practice Address - Street 1:2550 AMAR RD
Practice Address - Street 2:SUITE A2
Practice Address - City:WEST COVINA
Practice Address - State:GA
Practice Address - Zip Code:91792
Practice Address - Country:US
Practice Address - Phone:626-964-0099
Practice Address - Fax:626-964-2209
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45665208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A456650Medicaid
CAA45665Medicare ID - Type Unspecified
A61747Medicare UPIN