Provider Demographics
NPI:1235902974
Name:JIMENEZ MENDIOLA, YENLYS
Entity Type:Individual
Prefix:MS
First Name:YENLYS
Middle Name:
Last Name:JIMENEZ MENDIOLA
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 1:1025 UNIVERSAL REST PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5126
Mailing Address - Country:US
Mailing Address - Phone:321-746-7896
Mailing Address - Fax:
Practice Address - Street 1:1025 UNIVERSAL REST PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5126
Practice Address - Country:US
Practice Address - Phone:321-746-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1122162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist