Healthcare Provider Details

I. General information

NPI: 1366759607
Provider Name (Legal Business Name): CHARLES EDWARD JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 TELEPHONE RD STE 117
VENTURA CA
93003-5672
US

IV. Provider business mailing address

4601 TELEPHONE RD STE 117
VENTURA CA
93003-5672
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-7033
  • Fax: 805-852-1906
Mailing address:
  • Phone: 805-642-7033
  • Fax: 805-852-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: