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General NPI Number Information
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NPI Number | 1902606734
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Entity Type | Individual
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Provider Name | ELISA A JIMENEZ ACSW
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Gender | Female
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 7190 W SUNSET BLVD # 7D
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City | LOS ANGELES
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State | CA
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Zip | 90046-4415
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Country | US
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Telephone | 323-301-3962
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Fax |
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Provider Business Mailing Address
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Address Line | 2682 S PLEASANT AVE
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City | ONTARIO
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State | CA
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Zip | 91761-6798
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Country | US
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Telephone | 626-660-8072
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 102017
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License Number State | CA
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