Provider Demographics
NPI:1174898662
Name:JIMENEZ, ARIANE DOMINGO (PTA)
Entity type:Individual
Prefix:MISS
First Name:ARIANE
Middle Name:DOMINGO
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LANDIS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2628
Mailing Address - Country:US
Mailing Address - Phone:619-498-8450
Mailing Address - Fax:619-498-8453
Practice Address - Street 1:251 LANDIS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2628
Practice Address - Country:US
Practice Address - Phone:619-498-8450
Practice Address - Fax:619-498-8453
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist