Healthcare Provider Details

I. General information

NPI: 1790800381
Provider Name (Legal Business Name): LISA CYNTHIA JIMENEZ MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. LISA CYNTHIA RODRIGUEZ

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E GRAND AVE STE 115C
ARROYO GRANDE CA
93420-2461
US

IV. Provider business mailing address

130 W BRANCH ST STE B
ARROYO GRANDE CA
93420-6617
US

V. Phone/Fax

Practice location:
  • Phone: 805-668-2222
  • Fax:
Mailing address:
  • Phone: 661-717-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number85326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: