=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164227344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. FLOR ALEJANDRA JIMENEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7313 WHITTIER AVE
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90602-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-442-9129
-----------------------------------------------------
Fax | 310-943-3821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3639 E AVENUE R12
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93550-5786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-993-2295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 6776
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------