MEDICARE: JOANNA JACQUELINE IKENASIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker
2	1041C0700X	Clinical Social Worker	89772	CA

General Provider Information

NPI Number	:	1093120511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA JACQUELINE IKENASIO

Provider Business Mailing Address
First Line	:	5700 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2035
Country	:	US
Telephone Number	:	951-352-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2035
Country	:	US
Telephone Number	:	951-352-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	08/26/2025

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Directions to “ JOANNA JACQUELINE IKENASIO ” Practice Location

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