Healthcare Provider Details

I. General information

NPI: 1861688475
Provider Name (Legal Business Name): ANTHONY ALFRED JIMENEZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE SUITE 240
WASHINGTON DC
20003-4318
US

IV. Provider business mailing address

1755 A ST SE
WASHINGTON DC
20003-1618
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5440
  • Fax:
Mailing address:
  • Phone: 202-641-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1703
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: