Healthcare Provider Details

I. General information

NPI: 1093521593
Provider Name (Legal Business Name): ALMA A JIMENEZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 7TH ST
MADERA CA
93638-3780
US

IV. Provider business mailing address

21620 AVENUE 19
MADERA CA
93637-9754
US

V. Phone/Fax

Practice location:
  • Phone: 559-395-0451
  • Fax:
Mailing address:
  • Phone: 559-474-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number706320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: