Provider Demographics
NPI:1700343779
Name:JIMENEZ-PINZON, JOSEFINA
Entity Type:Individual
Prefix:MRS
First Name:JOSEFINA
Middle Name:
Last Name:JIMENEZ-PINZON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JOSEFINA
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:4425 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3629
Mailing Address - Country:US
Mailing Address - Phone:323-908-4283
Mailing Address - Fax:
Practice Address - Street 1:4425 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3629
Practice Address - Country:US
Practice Address - Phone:323-908-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA172V00000XMedicaid