Healthcare Provider Details

I. General information

NPI: 1669513586
Provider Name (Legal Business Name): ANTONIO JIMENEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 W SUNSET BLVD
LOS ANGELES CA
90027-5691
US

IV. Provider business mailing address

5419 W SUNSET BLVD STE 2
LOS ANGELES CA
90027-6415
US

V. Phone/Fax

Practice location:
  • Phone: 213-276-4055
  • Fax:
Mailing address:
  • Phone: 213-276-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number33379
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: