Provider Demographics
NPI:1508417148
Name:JIMENEZ LEON, CINTHIA
Entity Type:Individual
Prefix:
First Name:CINTHIA
Middle Name:
Last Name:JIMENEZ LEON
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 1:3512 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1823
Mailing Address - Country:US
Mailing Address - Phone:951-823-7722
Mailing Address - Fax:951-823-7722
Practice Address - Street 1:180 E MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4414
Practice Address - Country:US
Practice Address - Phone:877-421-1711
Practice Address - Fax:949-576-3913
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW975731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical