MEDICARE: ALEJANDRA JIMENEZ VELASCO

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
1	106H00000X	Marriage & Family Therapist	124406	CA
2	106H00000X	Marriage & Family Therapist	136544	CA

General Provider Information

NPI Number	:	1649617184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRA JIMENEZ VELASCO

Provider Business Mailing Address
First Line	:	5703 N WEST AVE STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2366
Country	:	US
Telephone Number	:	559-681-5710
Fax Number	:

Provider Business Practice Location Address
First Line	:	5703 N WEST AVE STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-2366
Country	:	US
Telephone Number	:	559-681-5710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	04/17/2023

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