Provider Demographics
NPI:1649617184
Name:JIMENEZ VELASCO, ALEJANDRA
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:JIMENEZ VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5703 N WEST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2366
Mailing Address - Country:US
Mailing Address - Phone:559-681-5710
Mailing Address - Fax:
Practice Address - Street 1:5703 N WEST AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2366
Practice Address - Country:US
Practice Address - Phone:559-681-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124406106H00000X
CA136544106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist