MEDICARE: MRS. MARTHA CATALINA JIMENEZ MFT INTERN

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	106H00000X	Marriage & Family Therapist	IMF 55799	CA

General Provider Information

NPI Number	:	1982872859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA CATALINA JIMENEZ MFT INTERN

Provider Business Mailing Address
First Line	:	PO BOX 1096
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-7096
Country	:	US
Telephone Number	:	310-480-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	8174 WESTPORT CIR
Second Line	:
City	:	DISCOVERY BAY
State	:	CA
Zip	:	94505-2680
Country	:	US
Telephone Number	:	310-480-8758
Fax Number	:

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

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	03/28/2022

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