Individual
PEPITO JIMENEZ DECENA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
13800 COPPERMINE RD # 124-A, HERNDON, VA 20171-6163
(571) 508-7144
(703) 935-0898
Mailing address
910 W REDWOOD RD, STERLING, VA 20164-5117
(571) 508-7144
Taxonomy
Speciality
Code
Description
License number
State
364SH0200X
Home Health Clinical Nurse Specialist
Primary
0002093395
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
VA
Enumeration date
07/20/2020
Last updated
07/20/2020
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