MEDICARE: ASHLEY ROBIN 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
1	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1518197177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ROBIN JIMENEZ

Provider Business Mailing Address
First Line	:	6830 BOARDWALK DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-9244
Country	:	US
Telephone Number	:	916-717-4385
Fax Number	:

Provider Business Practice Location Address
First Line	:	6830 BOARDWALK DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-9244
Country	:	US
Telephone Number	:	916-717-4385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	11/25/2024

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