Provider Demographics
NPI:1659905842
Name:JIMENEZ, YOVANI
Entity Type:Individual
Prefix:
First Name:YOVANI
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7716 GEORGETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-2800
Mailing Address - Country:US
Mailing Address - Phone:661-376-5279
Mailing Address - Fax:
Practice Address - Street 1:10417 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241
Practice Address - Country:US
Practice Address - Phone:661-376-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker