Provider Demographics
NPI:1417017971
Name:JIMENEZ, IRENE - (RN,PHN)
Entity Type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:-
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RN,PHN
Other - Prefix:MISS
Other - First Name:IRENE
Other - Middle Name:-
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:8708 PACIFIC HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-5123
Mailing Address - Country:US
Mailing Address - Phone:916-689-2056
Mailing Address - Fax:
Practice Address - Street 1:275 BECK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6804
Practice Address - Country:US
Practice Address - Phone:707-784-8650
Practice Address - Fax:707-421-7484
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288830163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health