Provider Demographics
NPI:1366642100
Name:MAURICIO E. JIMENEZ, M.D., P.A.
Entity Type:Organization
Organization Name:MAURICIO E. JIMENEZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-532-1222
Mailing Address - Street 1:1501 N MESA ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4137
Mailing Address - Country:US
Mailing Address - Phone:915-532-1222
Mailing Address - Fax:915-532-1551
Practice Address - Street 1:1501 N MESA ST STE 2B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4137
Practice Address - Country:US
Practice Address - Phone:915-532-1222
Practice Address - Fax:915-532-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty