Healthcare Provider Details

I. General information

NPI: 1710528237
Provider Name (Legal Business Name): DYNAMIC PSYCHOMETRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13361 N 56TH ST OFC B
TEMPLE TERRACE FL
33617-1161
US

IV. Provider business mailing address

13361 N 56TH ST OFC B
TEMPLE TERRACE FL
33617-1161
US

V. Phone/Fax

Practice location:
  • Phone: 727-279-5878
  • Fax: 833-720-9866
Mailing address:
  • Phone: 727-279-5878
  • Fax: 833-720-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA EMIL JIMENEZ
Title or Position: OWNER
Credential: PSY. D.
Phone: 813-503-3652