Healthcare Provider Details

I. General information

NPI: 1790614725
Provider Name (Legal Business Name): CRYSTAL JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7422 GARVEY AVE UNIT 204
ROSEMEAD CA
91770-2974
US

IV. Provider business mailing address

1306 N AVENUE 56
LOS ANGELES CA
90042-1832
US

V. Phone/Fax

Practice location:
  • Phone: 626-531-6999
  • Fax: 626-531-6999
Mailing address:
  • Phone: 562-650-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: