Provider Demographics
NPI:1346632353
Name:JIMENEZ MAGANA, LUZ HERMINIA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:HERMINIA
Last Name:JIMENEZ MAGANA
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 1:2261 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3721
Mailing Address - Country:US
Mailing Address - Phone:707-299-1508
Mailing Address - Fax:707-299-2120
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-299-1508
Practice Address - Fax:707-299-2120
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator