Provider Demographics
NPI:1093120511
Name:IKENASIO, JOANNA JACQUELINE
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:JACQUELINE
Last Name:IKENASIO
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:PO BOX 3171
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90711-3171
Mailing Address - Country:US
Mailing Address - Phone:951-584-3747
Mailing Address - Fax:
Practice Address - Street 1:2629 CLARENDON AVE FL 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4119
Practice Address - Country:US
Practice Address - Phone:323-584-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker