Healthcare Provider Details

I. General information

NPI: 1467970889
Provider Name (Legal Business Name): ELIZABETH JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 02/11/2022
Certification Date: 03/22/2021
Deactivation Date: 04/23/2019
Reactivation Date: 05/01/2019

III. Provider practice location address

505 N EUCLID ST STE 300
ANAHEIM CA
92801-5514
US

IV. Provider business mailing address

505 N EUCLID ST STE 300
ANAHEIM CA
92801-5514
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-5646
  • Fax:
Mailing address:
  • Phone: 714-871-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW100356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: