Provider Demographics
NPI:1568416097
Name:ARSENIO I. JIMENEZ, JR., M.D., P.C.
Entity Type:Organization
Organization Name:ARSENIO I. JIMENEZ, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARSENIO
Authorized Official - Middle Name:I
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:760-703-0691
Mailing Address - Street 1:750 E GRAND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4460
Mailing Address - Country:US
Mailing Address - Phone:760-233-0777
Mailing Address - Fax:760-233-8030
Practice Address - Street 1:750 E GRAND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4460
Practice Address - Country:US
Practice Address - Phone:760-233-0777
Practice Address - Fax:760-233-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204039261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01703942Medicaid
NY01703942Medicaid
NY769231Medicare ID - Type Unspecified