Provider Demographics
NPI:1417100769
Name:JIMENEZ, KATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 UPPER RAGSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5730
Mailing Address - Country:US
Mailing Address - Phone:831-648-7200
Mailing Address - Fax:831-648-7204
Practice Address - Street 1:12 UPPER RAGSDALE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-648-7200
Practice Address - Fax:831-648-7204
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19412363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical