Provider Demographics
NPI:1285142919
Name:JIMENEZ, CRISTAIN
Entity type:Individual
Prefix:MR
First Name:CRISTAIN
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PARRISH LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4826
Mailing Address - Country:US
Mailing Address - Phone:702-444-9340
Mailing Address - Fax:702-293-3664
Practice Address - Street 1:65 PARRISH LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-4826
Practice Address - Country:US
Practice Address - Phone:702-444-9340
Practice Address - Fax:702-293-3664
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid