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General NPI Number Information
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NPI Number | 1316427784
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Entity Type | Individual
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Provider Name | CANDACE JIMENEZ-LOGAN
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 316 E E ST
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City | ONTARIO
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State | CA
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Zip | 91764-3712
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Country | US
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Telephone | 909-983-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 11556 BARRETT DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7249
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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