Active NPI
Robert Gustavo Jimenez
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1053962845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 1926 Beverly Blvd
Los Angeles, CA 90057-2402 - Phone
- (213) 353-1140
- NPI assigned
- Sep 24, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
1926 Beverly Blvd
Los Angeles, CA 90057-2402
Mailing address
6737 Blewett Ave
Van Nuys, CA 91406-6013
Phone (818) 919-1441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 30, 2024 through Oct 30, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569283200000",
"number": "1053962845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6737 BLEWETT AVE",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914066013",
"telephone_number": "818-919-1441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1926 BEVERLY BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900572402",
"telephone_number": "213-353-1140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMENEZ",
"first_name": "ROBERT",
"middle_name": "GUSTAVO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-24",
"last_updated": "2019-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.