Basic Information
| Provider Information | |||||||||
| NPI: | 1225248529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENEZ | ||||||||
| FirstName: | LORENA | ||||||||
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| Credential: | B.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11741 E. SANTA FE SPRINGS | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11741 SANTA FE SPRINGS | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 10/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.