Provider Demographics
NPI:1407639131
Name:JIMENEZ, SABRINA A
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:A
Last Name:JIMENEZ
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 1:450 N RAYMOND AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3763
Mailing Address - Country:US
Mailing Address - Phone:626-665-0243
Mailing Address - Fax:
Practice Address - Street 1:450 N RAYMOND AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3763
Practice Address - Country:US
Practice Address - Phone:626-665-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5363163WL0100X
CA5352374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant