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NPI Code Detail

MEDICARE: RAUL JIMENEZ JR.

MEDICARE: RAUL JIMENEZ JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1043862956
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAUL JIMENEZ JR.
Provider Business Mailing Address
First Line : 10680 TREENA ST STE 170
Second Line :
City : SAN DIEGO
State : CA
Zip : 92131-2443
Country : US
Telephone Number : 442-271-5872
Fax Number :
Provider Business Practice Location Address
First Line : 10680 TREENA ST STE 170
Second Line :
City : SAN DIEGO
State : CA
Zip : 92131-2443
Country : US
Telephone Number : 442-271-5872
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2019
Last Update Date : 07/11/2019

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