Healthcare Provider Details

I. General information

NPI: 1508553116
Provider Name (Legal Business Name): JIMMENA RENA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 N WATERMAN AVE STE 1&2
SAN BERNARDINO CA
92404-5131
US

IV. Provider business mailing address

6711 ARLINGTON AVE STE C
RIVERSIDE CA
92504-1966
US

V. Phone/Fax

Practice location:
  • Phone: 909-494-7727
  • Fax:
Mailing address:
  • Phone: 951-352-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: