Provider Demographics
NPI:1669835831
Name:JIMENEZ, DANIEL ENRIQUE (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ENRIQUE
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 NW 9TH AVE
Mailing Address - Street 2:SUITE 3308
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1409
Mailing Address - Country:US
Mailing Address - Phone:305-355-9063
Mailing Address - Fax:305-355-9076
Practice Address - Street 1:1695 NW 9TH AVE
Practice Address - Street 2:SUITE 3308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1409
Practice Address - Country:US
Practice Address - Phone:305-355-9063
Practice Address - Fax:305-355-9076
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical