MEDICARE: REBECCA ARLENE JIMENEZ

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	171100000X	Acupuncturist	AK001245	PA

General Provider Information

NPI Number	:	1811490824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ARLENE JIMENEZ

Provider Business Mailing Address
First Line	:	4617 CEDAR AVE APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-2117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 E GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3326
Country	:	US
Telephone Number	:	978-870-6912
Fax Number	:

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

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	03/15/2018

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