Provider Demographics
NPI:1992882013
Name:GIMENEZ, LUIS A (LCSW #CA LCS13314)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:GIMENEZ
Suffix:
Gender:M
Credentials:LCSW #CA LCS13314
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5324
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031
Mailing Address - Country:US
Mailing Address - Phone:805-340-3995
Mailing Address - Fax:
Practice Address - Street 1:650 META ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7182
Practice Address - Country:US
Practice Address - Phone:805-340-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS13314103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist