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General NPI Number Information
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NPI Number | 1780251512
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Entity Type | Individual
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Provider Name | LISA YVETTE JIMENEZ
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Gender | Female
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 18109 PRINCE PHILIP DR STE 155
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City | OLNEY
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State | MD
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Zip | 20832-1591
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Country | US
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Telephone | 301-260-3280
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Fax |
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Provider Business Mailing Address
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Address Line | 600 WAYNE AVE
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City | SILVER SPRING
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State | MD
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Zip | 20910-5554
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Country | US
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Telephone | 301-364-8800
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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