Provider Demographics
NPI:1144893926
Name:MAGANA JIMENEZ, JORGE LUIS (RDN)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:MAGANA JIMENEZ
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8854 MOTTER LN
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5469
Mailing Address - Country:US
Mailing Address - Phone:703-217-7489
Mailing Address - Fax:
Practice Address - Street 1:8854 MOTTER LN
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5469
Practice Address - Country:US
Practice Address - Phone:703-217-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered