Active NPI
Jessica Marie Jimenez, PA-C
- Physician Assistant
- Costa Mesa, CA
National Provider Identifier
1306197819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA22326
- Practice address
- 1550 Superior Ave
Costa Mesa, CA 92627-3653 - Phone
- (949) 270-2100
- Fax
- (949) 650-4458
- NPI assigned
- Sep 24, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2012-0041 | NM | |
| Physician Assistant | 363A00000X | PA22326 | CA | Primary |
Addresses
Primary practice location
1550 Superior Ave
Costa Mesa, CA 92627-3653
Mailing address
1550 Superior Ave
Costa Mesa, CA 92627-3653
Phone (949) 270-2100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22326 | CA | MD | Pharmacy Technician |
| PA22326 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565136000000",
"number": "1306197819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 SUPERIOR AVE",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926273653",
"telephone_number": "949-270-2100",
"fax_number": "949-650-4458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1550 SUPERIOR AVE",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926273653",
"telephone_number": "949-270-2100",
"fax_number": "949-650-4458"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMENEZ",
"first_name": "JESSICA",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-24",
"last_updated": "2019-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "PA2012-0041",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA22326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.