Healthcare Provider Details

I. General information

NPI: 1033430715
Provider Name (Legal Business Name): MILITZA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 VISTA WAY 205
OCENSIDE CA
92056-3619
US

IV. Provider business mailing address

3142 VISTA WAY 205
OCEANSIDE CA
92056-3619
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: