Healthcare Provider Details

I. General information

NPI: 1093120511
Provider Name (Legal Business Name): JOANNA JACQUELINE IKENASIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARLINGTON AVE
RIVERSIDE CA
92504-2035
US

IV. Provider business mailing address

5700 ARLINGTON AVE
RIVERSIDE CA
92504-2035
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-1200
  • Fax:
Mailing address:
  • Phone: 951-352-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: