Healthcare Provider Details

I. General information

NPI: 1619444759
Provider Name (Legal Business Name): YARELI JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 RESPONSE RD STE 200
SACRAMENTO CA
95815-5255
US

IV. Provider business mailing address

3650 MT DIABLO BLVD STE 107
LAFAYETTE CA
94549-3780
US

V. Phone/Fax

Practice location:
  • Phone: 916-518-3187
  • Fax:
Mailing address:
  • Phone: 510-665-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: