Healthcare Provider Details

I. General information

NPI: 1740776368
Provider Name (Legal Business Name): NANCY JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 W MARCH LN
STOCKTON CA
95207-5731
US

IV. Provider business mailing address

87 W MARCH LN
STOCKTON CA
95207-5731
US

V. Phone/Fax

Practice location:
  • Phone: 877-828-8476
  • Fax:
Mailing address:
  • Phone: 877-828-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: