Provider Demographics
NPI:1467830604
Name:JIMENEZ, SANDRA I
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JIMENEZ
Suffix:I
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 1:212 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-2314
Mailing Address - Country:US
Mailing Address - Phone:915-253-0203
Mailing Address - Fax:
Practice Address - Street 1:212 RAMONA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-2314
Practice Address - Country:US
Practice Address - Phone:915-253-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home