Provider Demographics
NPI:1700136975
Name:JIMENEZ, ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
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 1:42564 FONTAINEBLEAU PARK LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-3933
Mailing Address - Country:US
Mailing Address - Phone:510-990-7935
Mailing Address - Fax:
Practice Address - Street 1:42564 FONTAINEBLEAU PARK LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-3933
Practice Address - Country:US
Practice Address - Phone:510-990-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health