Individual
BRIAN JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 N PEPPER AVE STE 1M107, COLTON, CA 92324-1819
(909) 580-2178
Mailing address
400 N PEPPER AVE STE 1M107, COLTON, CA 92324-1819
(909) 580-2178
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
58988
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/30/2019
Last updated
12/23/2020
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