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General NPI Number Information
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NPI Number | 1558099143
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Entity Type | Individual
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Provider Name | DR. CHRISTIAN JESUS JIMENEZ RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | CARRETERA 788, KM 0.1, TOMAS DE CASTRO 1
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-597-1527
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE EMAJAGUA 519, HACIENDAS BORINQUEN
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City | CAGUAS
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State | PR
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Zip | 00727
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Country | US
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Telephone |
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Fax |
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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 | 7368
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License Number State | PR
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