Healthcare Provider Details

I. General information

NPI: 1083989065
Provider Name (Legal Business Name): MS. JANETTE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 04/26/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST #1016
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

900 CORPORATE CENTER DR STE 350
MONTEREY PARK CA
91754-7620
US

V. Phone/Fax

Practice location:
  • Phone: 213-344-3799
  • Fax: 323-225-5672
Mailing address:
  • Phone: 323-526-4016
  • Fax: 323-526-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: