Provider Demographics
NPI:1538392717
Name:JIMENEZ, MICHELLE ANN IBARRA (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE ANN
Middle Name:IBARRA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 ZENAIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5626
Mailing Address - Country:US
Mailing Address - Phone:361-742-9430
Mailing Address - Fax:
Practice Address - Street 1:1102 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9105
Practice Address - Country:US
Practice Address - Phone:956-388-6000
Practice Address - Fax:956-289-2956
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3763208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics