Individual
DESTINY JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RADT-1
Contact information
Practice address
1601 2ND ST STE 104, SAN RAFAEL, CA 94901-2701
(415) 459-2395
Mailing address
1601 2ND ST STE 104, SAN RAFAEL, CA 94901-2701
(510) 309-0312
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Enumeration date
02/22/2021
Last updated
02/22/2021
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