Most Relevant Information
Provider Data
| NPI Number: | 1003567553 |
| Provider Name: | KELLY ANN JIMENEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 123831 |
Most Important Dates
| Enumeration Date: | 01/17/2022 |
| Last Updated: | 07/25/2024 |
Provider Practice Location
14677 MERRILL AVE
FONTANA
CA
923354219
Practice Location Phone/Fax
| Phone: | 9516432340 |
| Fax: |
Provider Mailing Location
14677 MERRILL AVE
FONTANA
CA
923354219
Provider Mailing Phone/Fax
| Phone: | 9516432340 |
| Fax: |