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General NPI Number Information
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NPI Number | 1194501973
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Entity Type | Individual
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Provider Name | JASON JIMENEZ PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 7000 W PALMETTO PARK RD STE 110
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City | BOCA RATON
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State | FL
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Zip | 33433-3429
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Country | US
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Telephone | 561-418-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 2029 N UNIVERSITY DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-6132
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Country | US
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Telephone | 954-751-0000
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Fax | 954-697-9516
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY11972
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License Number State | FL
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