Healthcare Provider Details

I. General information

NPI: 1497155360
Provider Name (Legal Business Name): ROBERTO JIMENEZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LONG BEACH BLVD STE 321
LONG BEACH CA
90807-4025
US

IV. Provider business mailing address

3605 LONG BEACH BLVD STE 321
LONG BEACH CA
90807-4025
US

V. Phone/Fax

Practice location:
  • Phone: 323-366-4994
  • Fax: 323-372-2669
Mailing address:
  • Phone: 323-366-4994
  • Fax: 323-372-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95011085
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number831722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: