Individual provider Active NPI

Tina Jimenez

  • Counseling Psychologist
  • Los Angeles, CA
National Provider Identifier
1699249359
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
PSY34781 Issued in CA
Practice address
1720 E 120TH St
Los Angeles, CA 90059-3052
Phone
(310) 668-4495
NPI assigned
Jan 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Counseling Psychologist 103TC1900X PSY34781 CA Primary

Addresses

Primary practice location

1720 E 120TH St
Los Angeles, CA 90059-3052

Mailing address

1720 E 120TH St
Los Angeles, CA 90059-3052
Phone (310) 668-4495

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250313003809 CA Practitioner - Clinical Psychologist 8426570995 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
UCSF Medical Group Business ServicesGroup PAC ID 3779497870, 1,533 clinicians

Practice addresses (Care Compare)

400 Parnassus Ave
San Francisco, CA 94143-2202

Hospital & facility affiliations

  • UCSF Medical Center Hospital, San Francisco, CA, CCN 050454

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Arts

State licenses

LicenseStateTypeSpecialty
PSY34781CAMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of California San Francisco Current Accepting new patients
UCSF Dept of Surgery CurrentSince Mar 5, 2025 Accepting new patients
University of California San Francisco CurrentSince Mar 5, 2025 Accepting new patients
UCSF Medical Group Business Services CurrentSince Mar 5, 2025 Accepting new patients
UCSF Medical Group Business Services CurrentSince Mar 5, 2025 Accepting new patients
University of California San Francisco CurrentSince Mar 5, 2025 Accepting new patients
University of California San Francisco Medical Center Past Accepting new patients

Locations

3100 San Pablo Ave
Berkeley, CA 94702
Phone (510) 985-5020

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

2001 The Embarcadero
Ste 1500
San Francisco, CA 94143
Phone (415) 353-1606

400 Parnassus Ave
Fl 8
San Francisco, CA 94143
Phone (415) 353-2273

400 Parnassus Ave
Fl 8A803
San Francisco, CA 94143

400 Parnassus Ave
#A632
San Francisco, CA 94143
Phone (415) 473-1000

2330 Post St
San Francisco, CA 94115
Phone (415) 502-4444

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1699249359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593052",
            "telephone_number": "310-668-4495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593052",
            "telephone_number": "310-668-4495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "TINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-16",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY34781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.