Provider Demographics
NPI:1245396092
Name:JIMENEZ, PATRICIA DELCARMEN (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DELCARMEN
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 1:1718 HOLLYVISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4626
Mailing Address - Country:US
Mailing Address - Phone:323-662-1052
Mailing Address - Fax:323-662-0267
Practice Address - Street 1:1718 HOLLYVISTA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-4626
Practice Address - Country:US
Practice Address - Phone:323-662-1052
Practice Address - Fax:323-662-0267
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12525363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12525Medicare ID - Type Unspecified
CAR40754Medicare UPIN