Individual
ERICA A JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1149 N EL DORADO ST, STOCKTON, CA 95202-1305
(209) 468-2335
(209) 468-0525
Mailing address
1149 N EL DORADO ST, STOCKTON, CA 95202-1305
(209) 468-2335
(209) 468-0525
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B9067308
DRIVERS LICENSE
CA
Enumeration date
05/14/2008
Last updated
05/14/2008
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