Rosita C. Jimenez, PERIODONTIST

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021.001004 Issued in IL

Practice address

2621 S Lawndale Ave
Suite B
Chicago, IL 60623-4520

Phone

(773) 762-0200

Fax

(773) 762-0201

NPI assigned

Nov 10, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362096000000",
    "number": "1356412530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3213 FOXRIDGE CT",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605173281",
            "telephone_number": "630-910-7213",
            "fax_number": "773-762-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 S LAWNDALE AVE",
            "address_2": "SUITE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234520",
            "telephone_number": "773-762-0200",
            "fax_number": "773-762-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "ROSITA",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "PERIODONTIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-10",
        "last_updated": "2013-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.015877",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021.001004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL WELLNESS PARTNERS",
            "identifier": "DWP11770",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miguel A Jimenez, D.C., S.A.
• Naomi Jimenez, LCSW
• Odiseo Jimenez
• Paula Andrea Jimenez
• Perla Jimenez
• Rossy Jimenez, CCC-SLP
• Sandra Jimenez, BSN RN
• Sarahi Jimenez
• Sofia Carleen Jimenez, PSY.D.
• Stephanie Jimenez, APRN FNP-BC

• Periodontics in Chicago, IL
• Providers in Chicago, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.