Provider Demographics
NPI:1396908869
Name:JIMENEZ, GLORIA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ANN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ANN
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:555 CAPITOL MALL
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4504
Mailing Address - Country:US
Mailing Address - Phone:916-441-0400
Mailing Address - Fax:
Practice Address - Street 1:555 CAPITOL MALL
Practice Address - Street 2:SUITE 260
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-4504
Practice Address - Country:US
Practice Address - Phone:916-441-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-05
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A10668208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program