Provider Demographics
NPI:1477217966
Name:JIMENEZ, ULYSSES ROMMEL (DPT)
Entity Type:Individual
Prefix:
First Name:ULYSSES
Middle Name:ROMMEL
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6586 AMBROSIA DR APT 5204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3140
Mailing Address - Country:US
Mailing Address - Phone:408-830-6691
Mailing Address - Fax:
Practice Address - Street 1:3191 SPORTS ARENA BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4569
Practice Address - Country:US
Practice Address - Phone:619-226-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist