Provider Demographics
NPI:1205222726
Name:JIMENEZ, GLORIMARI
Entity Type:Individual
Prefix:
First Name:GLORIMARI
Middle Name:
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:URB. SAN ANTONIO
Mailing Address - Street 2:CALLE DRAMA 2118
Mailing Address - City:PONCE
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00728
Mailing Address - Country:UM
Mailing Address - Phone:787-929-4102
Mailing Address - Fax:
Practice Address - Street 1:2118 CALLE DRAMA
Practice Address - Street 2:URB SAN ANTONIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-929-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical