Provider Demographics
NPI:1366001521
Name:CAMPO-JIMENEZ, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:CAMPO-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 1:9291 CUTLER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8835
Mailing Address - Country:US
Mailing Address - Phone:786-210-1591
Mailing Address - Fax:
Practice Address - Street 1:15291 NW 60TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2458
Practice Address - Country:US
Practice Address - Phone:786-615-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist