1346329851 NPI number — DR. FRANCIS ESCOLIN JIMENEZ M.D.

Table of content: DR. FRANCIS ESCOLIN JIMENEZ M.D. (NPI 1346329851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346329851 NPI number — DR. FRANCIS ESCOLIN JIMENEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ
Provider First Name:
FRANCIS
Provider Middle Name:
ESCOLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346329851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2810 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
STE 47
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89102-1960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-258-4469
Provider Business Mailing Address Fax Number:
702-259-0239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3009 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89102-1943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-258-4469
Provider Business Practice Location Address Fax Number:
702-259-0239
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9268 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 880504273 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 002018621 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: NV9268 . This is a "STATE LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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