Provider Demographics
NPI:1740012897
Name:JIMENEZ, BIANCA JAENNETTH
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:JAENNETTH
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 1:18245 CASABA RD
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-2024
Mailing Address - Country:US
Mailing Address - Phone:562-544-2733
Mailing Address - Fax:
Practice Address - Street 1:77711 FLORA RD
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-4103
Practice Address - Country:US
Practice Address - Phone:909-726-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician