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NPI Code Detail

MEDICARE: IVY JIMENEZ

MEDICARE: IVY 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1386595999
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVY JIMENEZ
Provider Business Mailing Address
First Line : 100 N PACIFIC COAST HWY STE 1400
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5602
Country : US
Telephone Number : 949-357-2556
Fax Number : 949-357-2556
Provider Business Practice Location Address
First Line : 5080 CALIFORNIA AVE STE 250
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0732
Country : US
Telephone Number : 661-258-3240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ IVY JIMENEZ ” Practice Location

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