Individual
ANGELINA CONSUELO JAIMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAS
Contact information
Practice address
4950 SAN BERNARDINO ST STE 101, MONTCLAIR, CA 91763-2328
(800) 249-1266
Mailing address
3380 LA SIERRA AVE # 104-242, RIVERSIDE, CA 92503-5271
(951) 299-7645
(951) 299-7510
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46-1597137
—
CA
Enumeration date
05/18/2022
Last updated
09/26/2022
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