Provider Demographics
NPI:1881128692
Name:JIMENEZ, ANA LILIA
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LILIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:LILIA
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTER NURSE
Mailing Address - Street 1:7230 BRYNHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4938
Mailing Address - Country:US
Mailing Address - Phone:310-924-0089
Mailing Address - Fax:
Practice Address - Street 1:7230 BRYNHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4938
Practice Address - Country:US
Practice Address - Phone:310-924-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651590163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse