Healthcare Provider Details

I. General information

NPI: 1831400415
Provider Name (Legal Business Name): LEONEL JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S.L STREET
DINUBA CA
93618-2657
US

IV. Provider business mailing address

144 S. L STREET
DINUBA CA
93618-2657
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-6680
  • Fax:
Mailing address:
  • Phone: 559-591-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: