MEDICARE: MS. SARA JIMENEZ MCSWEYN MSW

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	1041C0700X	Clinical Social Worker	LCS10199	CA

General Provider Information

NPI Number	:	1760688337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA JIMENEZ MCSWEYN MSW

Provider Business Mailing Address
First Line	:	1449 N BENTON WAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2216
Country	:	US
Telephone Number	:	213-220-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3227
Country	:	US
Telephone Number	:	213-483-6335
Fax Number	:	213-483-9876

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

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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