1205458288 NPI number — A STEP FORWARD, A PATH TO WELLNESS

Table of content: (NPI 1205458288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205458288 NPI number — A STEP FORWARD, A PATH TO WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A STEP FORWARD, A PATH TO WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MANUEL J JIMENEZ JR, MARRIAGE FAMILY THERAPIST, PROFESSIONAL CORP.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205458288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 GEER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TURLOCK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95380-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-406-7665
Provider Business Mailing Address Fax Number:
209-633-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 GEER RD STE 504
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURLOCK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95382-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-406-7665
Provider Business Practice Location Address Fax Number:
209-633-3031
Provider Enumeration Date:
05/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
JIMENEZ
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-406-7665

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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