Provider Demographics
NPI:1902550999
Name:FRANCO JIMENEZ, JENNIFER ABIGAIL
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ABIGAIL
Last Name:FRANCO 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 1:32895 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4634
Mailing Address - Country:US
Mailing Address - Phone:951-710-4169
Mailing Address - Fax:
Practice Address - Street 1:32895 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4634
Practice Address - Country:US
Practice Address - Phone:951-710-4169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF405357OtherDEPARTMENT OF MOTOR VEHICLES