Individual
EDITH JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2940 INLAND EMPIRE BLVD, ONTARIO, CA 91764-4898
(909) 458-1350
Mailing address
1517 S SULTANA AVE, ONTARIO, CA 91761-4239
(626) 221-4336
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
32810
CA
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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