Provider Demographics
NPI:1831705623
Name:JIMENEZ-LOPEZ, AIDA ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:ELIZABETH
Last Name:JIMENEZ-LOPEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15040 VALLEY BLVD SPC 31
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3321
Mailing Address - Country:US
Mailing Address - Phone:626-665-7978
Mailing Address - Fax:
Practice Address - Street 1:1240 N HACIENDA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1663
Practice Address - Country:US
Practice Address - Phone:626-850-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily