Healthcare Provider Details

I. General information

NPI: 1588292544
Provider Name (Legal Business Name): COUGER JIMENEZ JARAMILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 08/15/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

IV. Provider business mailing address

UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES 4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-4141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberT7957
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberT7957
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: