Basic Information
| Provider Information | |||||||||
| NPI: | 1255813374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIMENEZ-ESPINOZA | ||||||||
| FirstName: | LETICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9064 HILLSIDE RD | ||||||||
| Address2: | |||||||||
| City: | DELHI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953159338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092629805 | ||||||||
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| Practice Location | |||||||||
| Address1: | 627 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953404717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097236559 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2018 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.