Provider Demographics
NPI:1720254642
Name:JIMENEZ, AMALIA
Entity Type:Individual
Prefix:
First Name:AMALIA
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 1:39675 CEDAR BLVD
Mailing Address - Street 2:SUITE 156
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5489
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39675 CEDAR BLVD
Practice Address - Street 2:SUITE 156
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5489
Practice Address - Country:US
Practice Address - Phone:510-451-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist