Provider Demographics
NPI:1881250843
Name:JIMENEZ, DENNISSE I
Entity type:Individual
Prefix:
First Name:DENNISSE
Middle Name:I
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENNISSE
Other - Middle Name:ISABEL
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:417 MELISSA CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-6719
Mailing Address - Country:US
Mailing Address - Phone:661-371-5152
Mailing Address - Fax:
Practice Address - Street 1:8302 ESPRESSO DR STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5688
Practice Address - Country:US
Practice Address - Phone:661-771-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3894896103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst