Healthcare Provider Details

I. General information

NPI: 1730516204
Provider Name (Legal Business Name): BENITO JIMENEZ GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ELDON BAKER DR
FLINT MI
48507-1923
US

IV. Provider business mailing address

1110 ELDON BAKER DR
FLINT MI
48507-1923
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-2766
  • Fax:
Mailing address:
  • Phone: 810-232-2766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095919
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: