Healthcare Provider Details

I. General information

NPI: 1598672370
Provider Name (Legal Business Name): TAMARA ANNE JIMENEZ CADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4576 E SHIELDS AVE
FRESNO CA
93726-7220
US

IV. Provider business mailing address

3770 W BARSTOW AVE APT 104
FRESNO CA
93711-6603
US

V. Phone/Fax

Practice location:
  • Phone: 559-240-9206
  • Fax:
Mailing address:
  • Phone: 559-977-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA060491021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: