Provider Demographics
NPI:1104514942
Name:DANIEL JIMENEZ M.D., INC.
Entity type:Organization
Organization Name:DANIEL JIMENEZ M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-565-1077
Mailing Address - Street 1:801 N TUSTIN AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3610
Mailing Address - Country:US
Mailing Address - Phone:714-565-1077
Mailing Address - Fax:
Practice Address - Street 1:801 N TUSTIN AVE STE 601
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3610
Practice Address - Country:US
Practice Address - Phone:714-565-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL JIMENEZ M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service