Basic Information
| Provider Information | |||||||||
| NPI: | 1316074214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENEZ | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | C.A.S.LL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 E 11TH ST | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953406226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093816850 | ||||||||
| FaxNumber: | 2093853174 | ||||||||
| Practice Location | |||||||||
| Address1: | 2130 COOPER AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953484304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093816850 | ||||||||
| FaxNumber: | 2093853174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.