Provider Demographics
NPI:1366141848
Name:CJ MEDICAL CENTER LLC
Entity type:Organization
Organization Name:CJ MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:JIMENEZ POZO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:725-247-4519
Mailing Address - Street 1:835 SOUTH BOULDER HIGHWAY #335
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-1739
Mailing Address - Country:US
Mailing Address - Phone:702-551-4608
Mailing Address - Fax:725-215-9309
Practice Address - Street 1:835 SOUTH BOULDER HIGHWAY #335
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-1739
Practice Address - Country:US
Practice Address - Phone:702-551-4608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215579602OtherNPI