Healthcare Provider Details

I. General information

NPI: 1831000793
Provider Name (Legal Business Name): MATTHEW JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 REMICK AVE
ARLETA CA
91331-4223
US

IV. Provider business mailing address

1021 INMAN CIR
SIMI VALLEY CA
93065-4826
US

V. Phone/Fax

Practice location:
  • Phone: 818-714-2275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: