Healthcare Provider Details

I. General information

NPI: 1588445621
Provider Name (Legal Business Name): ADELLA RUTH JIMENEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

458 BUENA MESA DR
CALIMESA CA
92320-2133
US

V. Phone/Fax

Practice location:
  • Phone: 442-282-4909
  • Fax:
Mailing address:
  • Phone: 951-609-7178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number117245
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: