Provider Demographics
NPI:1437841400
Name:JIMENEZ, MONICA LUCINDA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LUCINDA
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 1:18420 VINCENNES ST APT 115
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2103
Mailing Address - Country:US
Mailing Address - Phone:510-816-8946
Mailing Address - Fax:
Practice Address - Street 1:18420 VINCENNES ST APT 115
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2103
Practice Address - Country:US
Practice Address - Phone:510-816-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician