Provider Demographics
NPI:1477913796
Name:JIMENEZ COLIN, MARIA DE LA LUZ (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE LA LUZ
Last Name:JIMENEZ COLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 BONITA RD
Mailing Address - Street 2:#233
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE ORTIZ RUBIO 260-B AHOS
Practice Address - Street 2:ZONA CENTRO
Practice Address - City:TECATE
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21400
Practice Address - Country:MX
Practice Address - Phone:01152665-654-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1728880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist