Provider Demographics
NPI:1679846190
Name:ARTHUR E. JIMENEZ, M.D., INC.
Entity Type:Organization
Organization Name:ARTHUR E. JIMENEZ, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:GUTIERREZ
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-245-2380
Mailing Address - Street 1:15381 7TH ST
Mailing Address - Street 2:SUITE 2 & 3
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3858
Mailing Address - Country:US
Mailing Address - Phone:760-245-2380
Mailing Address - Fax:760-245-2584
Practice Address - Street 1:15381 7TH ST
Practice Address - Street 2:SUITE 2 & 3
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3858
Practice Address - Country:US
Practice Address - Phone:760-245-2380
Practice Address - Fax:760-245-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A642702Medicaid
CAG88024Medicare UPIN
CA00A642701Medicare PIN