Individual provider Active NPI

Jose Alfredo Jimenez, AA

  • Community Health Worker
  • Los Angeles, CA
National Provider Identifier
1245882190
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
5000 W Sunset Blvd
Los Angeles, CA 90027-5861
Phone
(323) 439-8315
Fax
(909) 865-9281
NPI assigned
Jul 11, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Community Health Worker 172V00000X Primary

Addresses

Primary practice location

5000 W Sunset Blvd
Los Angeles, CA 90027-5861

Mailing address

2008 N Garey Ave
Pomona, CA 91767-2722
Phone (909) 623-6131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Associate of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-City Mental Health Authority CurrentSince May 1, 2020 Accepting new patients
Tri-City Mental Health Center PastSince May 1, 2020 Accepting new patients

Locations

2008 N Garey Ave
Pomona, CA 91767
Phone (909) 242-7640

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1245882190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131",
            "fax_number": "909-865-9281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275861",
            "telephone_number": "323-439-8315",
            "fax_number": "909-865-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "JOSE",
        "middle_name": "ALFREDO",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-11",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.