Basic Information
| Provider Information | |||||||||
| NPI: | 1730268327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIMENO | ||||||||
| FirstName: | ROSANNA | ||||||||
| MiddleName: | MARISSA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JIMENO | ||||||||
| OtherFirstName: | ROSSANA | ||||||||
| OtherMiddleName: | MARISSA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PSY.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 611 1/2 CORONEL PL | ||||||||
| Address2: | APT. B | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931015459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054515215 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 429 N SAN ANTONIO RD | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058841654 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | RPS# 2005215 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.