Healthcare Provider Details

I. General information

NPI: 1215650502
Provider Name (Legal Business Name): CYNTHIA R JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY R JIMENEZ CINDY JIMENEZ

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 90TH ST FL 2
DALY CITY CA
94015-1879
US

IV. Provider business mailing address

350 90TH ST FL 2
DALY CITY CA
94015-1879
US

V. Phone/Fax

Practice location:
  • Phone: 650-301-8490
  • Fax:
Mailing address:
  • Phone: 650-301-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1215650502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: