Provider Demographics
NPI:1942459722
Name:JIMENEZ, LILIANA NICHOLS
Entity Type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:NICHOLS
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 1:2922 FINE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4619
Mailing Address - Country:US
Mailing Address - Phone:559-892-9207
Mailing Address - Fax:
Practice Address - Street 1:14277 ROAD 28
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-5715
Practice Address - Country:US
Practice Address - Phone:559-673-3508
Practice Address - Fax:559-661-2818
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program