MEDICARE: ERICA 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	106E00000X	Assistant Behavior Analyst	10191	TX

General Provider Information

NPI Number	:	1871264002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA JIMENEZ

Provider Business Mailing Address
First Line	:	2825 VILLAGE PKWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2200
Country	:	US
Telephone Number	:	210-378-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 VILLAGE PKWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-2200
Country	:	US
Telephone Number	:	210-378-6109
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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Directions to “ ERICA JIMENEZ ” Practice Location

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