Provider Demographics
NPI:1730268327
Name:JIMENO, ROSANNA MARISSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:MARISSA
Last Name:JIMENO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROSSANA
Other - Middle Name:MARISSA
Other - Last Name:JIMENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:611 1/2 CORONEL PL
Mailing Address - Street 2:APT. B
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-5459
Mailing Address - Country:US
Mailing Address - Phone:805-451-5215
Mailing Address - Fax:
Practice Address - Street 1:429 N SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1399
Practice Address - Country:US
Practice Address - Phone:805-884-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS# 2005215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical