Provider Demographics
NPI:1275016156
Name:JIMENEZ, ANGELICA GALVAN (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:GALVAN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 COLDWATER CANYON AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605
Mailing Address - Country:US
Mailing Address - Phone:818-763-8836
Mailing Address - Fax:818-301-6305
Practice Address - Street 1:6801 COLDWATER CANYON AVE.
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605
Practice Address - Country:US
Practice Address - Phone:818-763-8836
Practice Address - Fax:818-301-6305
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020669363LP2300X
CA95044827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse