Provider Demographics
NPI:1356582761
Name:JIMENEZ, MONICA ALICIA (BA SOCIOLOGY)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ALICIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:BA SOCIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 CANTLAY ST
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4801
Mailing Address - Country:US
Mailing Address - Phone:818-939-8001
Mailing Address - Fax:
Practice Address - Street 1:10830 CANTLAY ST
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4801
Practice Address - Country:US
Practice Address - Phone:818-939-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner