Provider Demographics
NPI:1275399941
Name:JIMENEZ, LINDA (EDS, PPS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:EDS, PPS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, PPS
Mailing Address - Street 1:150 DISTRICT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-3626
Mailing Address - Country:US
Mailing Address - Phone:760-883-2700
Mailing Address - Fax:
Practice Address - Street 1:150 DISTRICT CENTER DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-3626
Practice Address - Country:US
Practice Address - Phone:760-883-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool