Healthcare Provider Details

I. General information

NPI: 1871122150
Provider Name (Legal Business Name): VIVIANA JIMENEZ MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 SAN VICENTE BLVD STE 310
LOS ANGELES CA
90048-5468
US

IV. Provider business mailing address

10836 SW 89TH ST
MIAMI FL
33176-1300
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-0751
  • Fax:
Mailing address:
  • Phone: 786-250-7559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA194031
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA194031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: