MEDICARE: ANDREW EDWARD 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	106S00000X	Behavior Technician	171027866	CO

General Provider Information

NPI Number	:	1841157476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW EDWARD JIMENEZ

Provider Business Mailing Address
First Line	:	6876 VOLGA DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-9661
Country	:	US
Telephone Number	:	719-597-0822
Fax Number	:

Provider Business Practice Location Address
First Line	:	6436 S US HIGHWAY 85-87 STE U
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1007
Country	:	US
Telephone Number	:	719-822-0460
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ ANDREW EDWARD JIMENEZ ” Practice Location

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