Healthcare Provider Details

I. General information

NPI: 1982535274
Provider Name (Legal Business Name): NOAH JIMENEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W LUGONIA AVE
REDLANDS CA
92374-2233
US

IV. Provider business mailing address

34286 VENTURI AVE
BEAUMONT CA
92223-7471
US

V. Phone/Fax

Practice location:
  • Phone: 909-730-5561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: