Healthcare Provider Details

I. General information

NPI: 1003337411
Provider Name (Legal Business Name): JANESSA LYNETTE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 DUBLIN BLVD STE 200
DUBLIN CA
94568-2827
US

IV. Provider business mailing address

PO BOX 511
TRACY CA
95378-0511
US

V. Phone/Fax

Practice location:
  • Phone: 925-222-5207
  • Fax:
Mailing address:
  • Phone: 925-222-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: