Provider Demographics
NPI:1700400215
Name:JIMENEZ, VANESSA MARIA (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 VISTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5064
Mailing Address - Country:US
Mailing Address - Phone:323-600-5061
Mailing Address - Fax:
Practice Address - Street 1:14850 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9509
Practice Address - Country:US
Practice Address - Phone:909-597-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist