Provider Demographics
NPI:1396752689
Name:JIMENEZ, CONCEPCION (FNP)
Entity type:Individual
Prefix:MRS
First Name:CONCEPCION
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CONCEPCION
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1800 WILSHIRE BLVD
Mailing Address - Street 2:PAJA MEDICAL GROUP,INC.
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-484-9934
Mailing Address - Fax:213-484-9939
Practice Address - Street 1:1800 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3602
Practice Address - Country:US
Practice Address - Phone:213-484-9934
Practice Address - Fax:213-484-9939
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN295493, NP8740363LF0000X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN295493, NP8740OtherFNP