Provider Demographics
NPI:1295503712
Name:JIMENEZ-VIDRIO, HALEY ALESSANDRA
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ALESSANDRA
Last Name:JIMENEZ-VIDRIO
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 1:6831 TOLER AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6993
Mailing Address - Country:US
Mailing Address - Phone:562-922-4346
Mailing Address - Fax:
Practice Address - Street 1:3491 ELM AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4430
Practice Address - Country:US
Practice Address - Phone:833-223-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician