Provider Demographics
NPI:1164242418
Name:JIMENEZ, EMILY MARY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARY
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 1:111 S BARRANCA ST APT 310
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2256
Mailing Address - Country:US
Mailing Address - Phone:626-420-4516
Mailing Address - Fax:
Practice Address - Street 1:6001 CLARA ST
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4723
Practice Address - Country:US
Practice Address - Phone:562-806-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist