Provider Demographics
NPI:1073271789
Name:JIMENEZ, AMANDA DALIA (SLPA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DALIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 LOCHNESS CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3200
Mailing Address - Country:US
Mailing Address - Phone:714-483-0134
Mailing Address - Fax:
Practice Address - Street 1:7721 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6301
Practice Address - Country:US
Practice Address - Phone:310-553-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28672355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant