Healthcare Provider Details

I. General information

NPI: 1487986659
Provider Name (Legal Business Name): JHEMAYA QUEDI GIMENEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N CONLON AVE
WEST COVINA CA
91790-2104
US

IV. Provider business mailing address

225 N CONLON AVE
WEST COVINA CA
91790-2104
US

V. Phone/Fax

Practice location:
  • Phone: 217-741-8840
  • Fax:
Mailing address:
  • Phone: 217-741-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number37478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: