Active NPI
Angelina Consuelo Jaimez, AAS
- Case Manager/Care Coordinator
- Montclair, CA
National Provider Identifier
1740927987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 4950 San Bernardino St Ste 101
Montclair, CA 91763-2328 - Phone
- (800) 249-1266
- NPI assigned
- May 18, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
4950 San Bernardino St Ste 101
Montclair, CA 91763-2328
Mailing address
3380 La Sierra Ave # 104-242
Riverside, CA 92503-5271
Phone (951) 299-7645
Other practice location 1
5425 Sierra Vista Ave
Riverside, CA 92505-3113
Phone (951) 299-7645
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46-1597137 | Medicaid | CA |
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 Applied Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harvest Safe Haven for Boys | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Riverside, CA
- NPI 1174132807
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1740927987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3380 LA SIERRA AVE # 104-242",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925035271",
"telephone_number": "951-299-7645",
"fax_number": "951-299-7510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4950 SAN BERNARDINO ST STE 101",
"city": "MONTCLAIR",
"state": "CA",
"postal_code": "917632328",
"telephone_number": "800-249-1266"
}
],
"practiceLocations": [
{
"address_1": "5425 Sierra Vista Ave",
"address_purpose": "LOCATION",
"city": "Riverside",
"state": "CA",
"postal_code": "925053113",
"country_code": "US",
"telephone_number": "951-299-7645",
"fax_number": "951-299-7510",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JAIMEZ",
"first_name": "ANGELINA",
"middle_name": "CONSUELO",
"credential": "AAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-18",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "46-1597137",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montclair, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.