Healthcare Provider Details

I. General information

NPI: 1548472806
Provider Name (Legal Business Name): ERIKA K. JOHNSON-JIMENEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13170 CENTRAL AVE SE SUITE B420
ALBUQUERQUE NM
87123
US

IV. Provider business mailing address

13170 CENTRAL AVE SE SUITE B420
ALBUQUERQUE NM
87123
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-0161
  • Fax: 505-544-4648
Mailing address:
  • Phone: 505-385-0161
  • Fax: 505-544-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0952
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: