Healthcare Provider Details

I. General information

NPI: 1295666378
Provider Name (Legal Business Name): ALBERT JIMENEZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 MESA RD
COLORADO SPRINGS CO
80904-1036
US

IV. Provider business mailing address

2225 HOODOO DR
COLORADO SPRINGS CO
80919-2930
US

V. Phone/Fax

Practice location:
  • Phone: 818-731-1792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0028262
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: