Provider Demographics
NPI:1972335545
Name:JIMENEZ ANAYA, BETHSAIDA (LCDA)
Entity type:Individual
Prefix:MRS
First Name:BETHSAIDA
Middle Name:
Last Name:JIMENEZ ANAYA
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB VILLA LA MARINA
Mailing Address - Street 2:CALLE INDUS #1
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-518-4407
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA LA MARINA
Practice Address - Street 2:CALLE INDUS #1
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-518-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6894103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty