Provider Demographics
NPI:1144451113
Name:JIMENEZ, MELISSA NICOLE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name: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 1:2149 SONADOR CMNS
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4563
Mailing Address - Country:US
Mailing Address - Phone:832-344-7616
Mailing Address - Fax:
Practice Address - Street 1:1885 LUNDY AVE
Practice Address - Street 2:STE. 223
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1887
Practice Address - Country:US
Practice Address - Phone:408-284-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist