Provider Demographics
NPI:1205991577
Name:JIMENEZ, CESAR (DDS)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-7245
Mailing Address - Country:US
Mailing Address - Phone:619-442-0707
Mailing Address - Fax:619-442-4931
Practice Address - Street 1:1209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7245
Practice Address - Country:US
Practice Address - Phone:619-442-0707
Practice Address - Fax:619-442-4931
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43980OtherMEDI-CAL DENTAL PROGRAM