Provider Demographics
NPI:1225738073
Name:JIMENEZ, ITZEL (DPT)
Entity Type:Individual
Prefix:
First Name:ITZEL
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ITZEL
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:225 D AVE APT E
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1359
Mailing Address - Country:US
Mailing Address - Phone:623-433-6498
Mailing Address - Fax:
Practice Address - Street 1:225 D AVE APT E
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1359
Practice Address - Country:US
Practice Address - Phone:623-433-6498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist