Provider Demographics
NPI:1205024098
Name:JIMENEZ, BERNICE
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:APT. #303
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90609-1128
Mailing Address - Country:US
Mailing Address - Phone:562-207-9691
Mailing Address - Fax:
Practice Address - Street 1:6055 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2418
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:323-346-0966
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner