Provider Demographics
NPI:1417210006
Name:JIMENEZ, AQUILINA (SPECIAL INSTRUCTOR)
Entity Type:Individual
Prefix:
First Name:AQUILINA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:SPECIAL INSTRUCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 ANTHONY AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5388
Mailing Address - Country:US
Mailing Address - Phone:718-731-9533
Mailing Address - Fax:
Practice Address - Street 1:1911 ANTHONY AVE APT 2C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5388
Practice Address - Country:US
Practice Address - Phone:718-731-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist