Provider Demographics
NPI:1306599337
Name:JIMENEZ, MARISELA
Entity type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 DOWNEY AVE UNIT 342
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5830
Mailing Address - Country:US
Mailing Address - Phone:480-468-9515
Mailing Address - Fax:
Practice Address - Street 1:15000 DOWNEY AVE UNIT 342
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5830
Practice Address - Country:US
Practice Address - Phone:480-468-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)