Healthcare Provider Details

I. General information

NPI: 1417821356
Provider Name (Legal Business Name): JOSEPH B JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date: 04/22/2026
Reactivation Date: 05/12/2026

III. Provider practice location address

6330 RUGBY AVE STE 200
HUNTINGTON PARK CA
90255-6938
US

IV. Provider business mailing address

12815 OAK ST APT F
WHITTIER CA
90602-2920
US

V. Phone/Fax

Practice location:
  • Phone: 323-826-6300
  • Fax:
Mailing address:
  • Phone: 323-826-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: