Provider Demographics
NPI:1437134327
Name:SANDOVAL JIMENEZ, YARIMAR MARIA (AUD)
Entity Type:Individual
Prefix:MRS
First Name:YARIMAR
Middle Name:MARIA
Last Name:SANDOVAL JIMENEZ
Suffix:
Gender:F
Credentials:AUD
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 9741
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-8741
Mailing Address - Country:US
Mailing Address - Phone:787-714-1315
Mailing Address - Fax:787-714-1315
Practice Address - Street 1:12 CALLE BARCELO
Practice Address - Street 2:ESQUINO CARR 173
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3446
Practice Address - Country:US
Practice Address - Phone:787-714-1315
Practice Address - Fax:787-714-1315
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR460231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR60237Medicare ID - Type Unspecified
R59245Medicare UPIN