Healthcare Provider Details

I. General information

NPI: 1487328779
Provider Name (Legal Business Name): ALMA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST STE 100
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

16808 MAIN ST # D-245
HESPERIA CA
92345-7922
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-7279
  • Fax:
Mailing address:
  • Phone: 714-296-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: