Provider Demographics
NPI:1003388984
Name:JIMENEZ, NAYELI CRUZ LOPEZ
Entity Type:Individual
Prefix:
First Name:NAYELI
Middle Name:CRUZ LOPEZ
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34136 SE AIRPORT LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-7408
Mailing Address - Country:US
Mailing Address - Phone:503-298-3946
Mailing Address - Fax:
Practice Address - Street 1:34136 SE AIRPORT LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7408
Practice Address - Country:US
Practice Address - Phone:503-298-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty