Healthcare Provider Details

I. General information

NPI: 1346604923
Provider Name (Legal Business Name): WENDY JIMENEZ RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY JIMENEZ RD, CDE

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9463 CARLTON OAKS DR UNIT C
SANTEE CA
92071-2532
US

IV. Provider business mailing address

10236 BRIGHTWOOD LN UNIT 6
SANTEE CA
92071-8461
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2300
  • Fax:
Mailing address:
  • Phone: 818-634-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number925883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: