MEDICARE: JENNIFER ABIGAIL FRANCO 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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F405357	OTHER	CA	DEPARTMENT OF MOTOR VEHICLES

General Provider Information

NPI Number	:	1902550999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ABIGAIL FRANCO JIMENEZ

Provider Business Mailing Address
First Line	:	32895 VALLEY VIEW AVE
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4634
Country	:	US
Telephone Number	:	951-710-4169
Fax Number	:

Provider Business Practice Location Address
First Line	:	32895 VALLEY VIEW AVE
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4634
Country	:	US
Telephone Number	:	951-710-4169
Fax Number	:

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

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/08/2022

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