Provider Demographics
NPI:1437979085
Name:JIMENEZ, CRUZ ANTONIO JR
Entity type:Individual
Prefix:
First Name:CRUZ
Middle Name:ANTONIO
Last Name:JIMENEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 W LUXTON LN
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-4405
Mailing Address - Country:US
Mailing Address - Phone:623-845-2434
Mailing Address - Fax:
Practice Address - Street 1:10211 W LUXTON LN
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-4405
Practice Address - Country:US
Practice Address - Phone:623-845-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program