Healthcare Provider Details

I. General information

NPI: 1285242594
Provider Name (Legal Business Name): ROCIO JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD, MAILSTOP #53
LOS ANGELES CA
90027
US

IV. Provider business mailing address

4650 SUNSET BLVD, MAILSTOP #53
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 626-641-4660
  • Fax:
Mailing address:
  • Phone: 626-641-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: