Provider Demographics
NPI:1386685436
Name:JIMENEZ, JOHN RUBEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RUBEN
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:LCSW
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 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:4700 SPRING ST
Practice Address - Street 2:SUITE 220
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5274
Practice Address - Country:US
Practice Address - Phone:619-667-3380
Practice Address - Fax:619-667-0815
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS232041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical