MEDICARE: MR. BIEN JIMENEZ DECENA JR. PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1649526989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BIEN JIMENEZ DECENA JR. PA-C

Provider Business Mailing Address
First Line	:	ROOM 97 EEOB
Second Line	:	WHITE HOUSE MEDICAL UNIT
City	:	WASHINGTON
State	:	DC
Zip	:	20502
Country	:	US
Telephone Number	:	202-757-2476
Fax Number	:	202-757-2472

Provider Business Practice Location Address
First Line	:	ROOM 97 EEOB
Second Line	:	WHITE HOUSE MEDICAL UNIT
City	:	WASHINGTON
State	:	DC
Zip	:	20502
Country	:	US
Telephone Number	:	202-757-2476
Fax Number	:	202-757-2472

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	02/14/2017

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Directions to “ MR. BIEN JIMENEZ DECENA JR. PA-C” Practice Location

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