1235797556 NPI number — MS. JOSEPHINE ABISHA JIMENEZ M.A., SLP

Table of content: MS. JOSEPHINE ABISHA JIMENEZ M.A., SLP (NPI 1235797556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235797556 NPI number — MS. JOSEPHINE ABISHA JIMENEZ M.A., SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ
Provider First Name:
JOSEPHINE
Provider Middle Name:
ABISHA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARTOLOME
Provider Other First Name:
JOSEPHINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235797556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20920 SHEARER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90745-1232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-518-4867
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3521 LOMITA BLVD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-5040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-856-8528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com