Individual
TIMOTHY EUGENE JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
41751 KUHIO HIGHWAY, FRIENDSHIP HOUSE PSYCHO SOCIAL REHABILITATION PROGRAM, KAPAA, HI 96746-2064
(808) 821-4480
(808) 821-4483
Mailing address
33212 KUHIO HIGHWAY, KAUAI COMMUNITY MENTAL HEALTH CENTER, LIHUE, HI 96766-1142
(808) 274-3190
(808) 274-3194
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53937202
—
HI
Enumeration date
02/27/2007
Last updated
07/08/2007
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