Provider Demographics
NPI:1346661279
Name:JIMENEZ, SUZANNE MARIE (RD, LND)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RD, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CARR 169 APT 401
Mailing Address - Street 2:COND BALCONES DE GUAYNABO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-314-9305
Mailing Address - Fax:
Practice Address - Street 1:PROFESSIONAL PLAZA CARR 908 KM 0.4
Practice Address - Street 2:SUITE A2, TEJAS
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-314-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1045612133V00000X
PR1859133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered