Provider Demographics
NPI:1407199649
Name:JIMENEZ, DAMARIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:DAMARIS
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1350
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:
Practice Address - Street 1:ANISETO DIAZ ST. INT. 876
Practice Address - Street 2:
Practice Address - City:SAINT JUST
Practice Address - State:PR
Practice Address - Zip Code:00978
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28675163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse