Provider Demographics
NPI:1063045052
Name:JIMENEZ DEL TORO, EMANUEL (MA)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:JIMENEZ DEL TORO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CALLE ZUANIA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1686
Mailing Address - Country:US
Mailing Address - Phone:787-246-4680
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH STE 606
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3746
Practice Address - Country:US
Practice Address - Phone:787-246-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6372103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty