Provider Demographics
NPI:1790981983
Name:JIMENEZ, LINDA MARTINEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARTINEZ
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:MARTINEZ
Other - Last Name:JIMENEZ-PACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:18800 AMAR RD STE C3
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4177
Mailing Address - Country:US
Mailing Address - Phone:626-913-7359
Mailing Address - Fax:626-913-2354
Practice Address - Street 1:18800 AMAR RD STE C3
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4177
Practice Address - Country:US
Practice Address - Phone:626-913-7359
Practice Address - Fax:626-913-2354
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice