Provider Demographics
NPI:1952199986
Name:JIMENEZ, BRANDI ANN
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:ANN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7576 W DARREL RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7086
Mailing Address - Country:US
Mailing Address - Phone:623-296-4535
Mailing Address - Fax:
Practice Address - Street 1:7576 W DARREL RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7086
Practice Address - Country:US
Practice Address - Phone:623-296-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH10482320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness