Provider Demographics
NPI:1609866870
Name:JIMENEZ, ANTONIO S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:S
Last Name:JIMENEZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:10580 ARROWHEAD DRIVE
Mailing Address - Street 2:FAIRFAX HEALTH CENTER
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:571-432-2680
Mailing Address - Fax:571-432-2795
Practice Address - Street 1:10580 ARROWHEAD DRIVE
Practice Address - Street 2:FAIRFAX HEALTH CENTER
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:571-432-2680
Practice Address - Fax:571-432-2795
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-03-05
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Provider Licenses
StateLicense IDTaxonomies
VA0101055035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine