Provider Demographics
NPI:1932083920
Name:JIMENZ, ESEQUIEL
Entity type:Individual
Prefix:
First Name:ESEQUIEL
Middle Name:
Last Name:JIMENZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 DELTA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3657
Mailing Address - Country:US
Mailing Address - Phone:626-695-6195
Mailing Address - Fax:
Practice Address - Street 1:10418 VALLEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3600
Practice Address - Country:US
Practice Address - Phone:626-258-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25582225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist