Provider Demographics
NPI:1639262157
Name:MICHEL JEAN GIMENO
Entity Type:Organization
Organization Name:MICHEL JEAN GIMENO
Other - Org Name:STRESS AND PHOBIA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIMENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-799-3350
Mailing Address - Street 1:2531 LANDMARK DR
Mailing Address - Street 2:STE 207
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761
Mailing Address - Country:US
Mailing Address - Phone:727-799-3350
Mailing Address - Fax:727-725-5548
Practice Address - Street 1:2531 LANDMARK DR
Practice Address - Street 2:STE 207
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-799-3350
Practice Address - Fax:727-725-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME349552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty