1649526989 NPI number — MR. BIEN JIMENEZ DECENA JR. PA-C

Table of content: MELEINE LANDRY KONAN MD, MS (NPI 1811789480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649526989 NPI number — MR. BIEN JIMENEZ DECENA JR. PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECENA
Provider First Name:
BIEN
Provider Middle Name:
JIMENEZ
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649526989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROOM 97 EEOB
Provider Second Line Business Practice Location Address:
WHITE HOUSE MEDICAL UNIT
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-757-2476
Provider Business Practice Location Address Fax Number:
202-757-2472
Provider Enumeration Date:
07/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com