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NPI Code Detail

MEDICARE: ERICA A JIMENEZ

MEDICARE: ERICA A JIMENEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B9067308OTHERCADRIVERS LICENSE

General Provider Information

NPI Number : 1083881338
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA A JIMENEZ
Provider Business Mailing Address
First Line : 1149 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-468-2335
Fax Number : 209-468-0525
Provider Business Practice Location Address
First Line : 1149 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-468-2335
Fax Number : 209-468-0525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2008
Last Update Date : 05/14/2008

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Directions to “ ERICA A JIMENEZ ” Practice Location

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