Provider Demographics
NPI:1407440670
Name:JIMENEZ, ANDREA LIDA (DPT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LIDA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6070 AVENIDA ENCINAS STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1001
Mailing Address - Country:US
Mailing Address - Phone:760-444-0102
Mailing Address - Fax:760-688-3131
Practice Address - Street 1:3704 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1812
Practice Address - Country:US
Practice Address - Phone:858-509-9600
Practice Address - Fax:858-790-8877
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA299808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist