Healthcare Provider Details

I. General information

NPI: 1356057673
Provider Name (Legal Business Name): ANDREW REYNALDO JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14140 BEACH BLVD STE 155
WESTMINSTER CA
92683-4453
US

IV. Provider business mailing address

14140 BEACH BLVD STE 155
WESTMINSTER CA
92683-4453
US

V. Phone/Fax

Practice location:
  • Phone: 714-896-7556
  • Fax: 714-896-7564
Mailing address:
  • Phone: 714-896-7556
  • Fax: 714-896-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT152436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: