Provider Demographics
NPI:1598909103
Name:JIMENEZ, ANA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 ENCLAVE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8264
Mailing Address - Country:US
Mailing Address - Phone:260-446-2724
Mailing Address - Fax:
Practice Address - Street 1:520 SUPERIOR AVE STE 225
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3667
Practice Address - Country:US
Practice Address - Phone:949-360-0300
Practice Address - Fax:949-360-6932
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000833A363AM0700X
CA23197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical