MEDICARE: MR. ALBERT A. JIMENEZ LCDC, CART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	9995	TX

General Provider Information

NPI Number	:	1538484282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT A. JIMENEZ LCDC, CART

Provider Business Mailing Address
First Line	:	P.O. BOX 828
Second Line	:
City	:	CASTROVILLE
State	:	TX
Zip	:	78009
Country	:	US
Telephone Number	:	210-619-6020
Fax Number	:

Provider Business Practice Location Address
First Line	:	5203 OLD PEARSALL RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78242
Country	:	US
Telephone Number	:	210-277-7799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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