Ageless Alpha LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

AGELESS ALPHA LLC

Practice address

1289 S Bridgegate Dr
Gilbert, AZ 85296-8227

Phone

(575) 574-7338

NPI assigned

May 8, 2023

Last updated

May 8, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jesse Cisneros Jimenez Jr., NPNPI 1124745260

Title

Ceo

Phone

(575) 574-7338

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jesse Cisneros Jimenez Jr., MSN, FNP-BC

  • Family Nurse Practitioner
  • Gilbert, AZ
  • NPI 1124745260
  Authorized official Same address or phone

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683504000000",
    "number": "1730878455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1289 S BRIDGEGATE DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852968227",
            "telephone_number": "575-574-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1289 S BRIDGEGATE DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852968227",
            "telephone_number": "575-574-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS ALPHA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-08",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "CISNEROS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-574-7338",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.