Provider Demographics
NPI:1023833563
Name:JIMENEZ, JOSEPH MATTHEW
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MATTHEW
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 1:10983 WELLWORTH AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 S. FREMONT AVE
Practice Address - Street 2:BUILDING A10 SOUTH, SUITE 10100
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803
Practice Address - Country:US
Practice Address - Phone:626-759-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician