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General NPI Number Information
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NPI Number | 1982142410
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Entity Type | Individual
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Provider Name | EDGAR LEONEL JIMENEZ
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Gender | Male
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 555 RESERVOIR DR . SUITE 204-A
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City | SAN DIEGO
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State | CA
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Zip | 92120
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Country | US
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Telephone | 619-822-1800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1764
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City | CAMARILLO
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State | CA
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Zip | 93011-1764
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Country | US
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Telephone | 805-284-5403
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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