| Mitzi T. Jimenez Md Pa | |
|
910 S Wayside Dr Ste 150 Houston TX 77023-3430 | |
| (713) 923-6333 | |
| (713) 923-4197 |
| Full Name | Mitzi T. Jimenez Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 910 S Wayside Dr Ste 150, Houston, Texas |
| Authorized Official Name and Position | Mitzi T Jimenez (DIRECTOR) |
| Authorized Official Contact | 7139236333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mitzi T. Jimenez Md Pa Po Box 231233 Houston TX 77223-1233 Ph: (713) 923-6333 | Mitzi T. Jimenez Md Pa 910 S Wayside Dr Ste 150 Houston TX 77023-3430 Ph: (713) 923-6333 |
| NPI Number | 1255618112 |
|---|---|
| Provider Enumeration Date | 11/07/2011 |
| Last Update Date | 05/21/2020 |
| Medicare PECOS PAC ID | 6608038328 |
|---|---|
| Medicare Enrollment ID | O20120425000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255618112 | NPI | - | NPPES |
| F6790 | Other | TX | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | F-6790 (Texas) | Primary |
| Provider Name | Mitzi T Jimenez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912941774 PECOS PAC ID: 1850443581 Enrollment ID: I20090710000144 |
| Provider Name | Rudens Viera Galvez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598332207 PECOS PAC ID: 2668861352 Enrollment ID: I20211118001780 |
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