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1720603046 NPI number — PHOENIX J JIMENEZ CSW

NPI Number: 1720603046
Health Care Provider/Practitioner: PHOENIX J JIMENEZ CSW

Information about “1720603046” NPI (PHOENIX J JIMENEZ CSW) exists in 1720603046 in HTML format HTML  |  1720603046 in plain Text format TXT  |  1720603046 in PDF (Portable Document Format) PDF  |  1720603046 in an XML format XML  formats.

NPI Number : 1720603046 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720603046",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JIMENEZ",
    "FirstName": "PHOENIX",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1375 N SCOTTSDALE RD STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SCOTTSDALE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85257-3429",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "844-808-7792",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2940 N CHURCH ST STE 303",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAYTON",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84040-6617",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-935-4171",
    "PracticeLocationAddressFaxNumber": "385-227-8653",
    "EnumerationDate": "06/11/2020",
    "LastUpdateDate": "03/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "02/28/2025",
    "NPIReactivationDate": "03/18/2025",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "14200073-3502",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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