Healthcare Provider Details

I. General information

NPI: 1659567022
Provider Name (Legal Business Name): SANDRA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

IV. Provider business mailing address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

V. Phone/Fax

Practice location:
  • Phone: 562-922-7488
  • Fax:
Mailing address:
  • Phone: 562-922-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120370
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: