Healthcare Provider Details

I. General information

NPI: 1245145481
Provider Name (Legal Business Name): MS. JESSICA MARIE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 40TH ST
OAKLAND CA
94609-2633
US

IV. Provider business mailing address

26409 GADING RD APT 9D
HAYWARD CA
94544-3603
US

V. Phone/Fax

Practice location:
  • Phone: 510-613-0330
  • Fax:
Mailing address:
  • Phone: 510-589-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: