Provider Demographics
NPI:1467988808
Name:INIGUEZ, JAZMINE MONIECE
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:MONIECE
Last Name:INIGUEZ
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 1:7741 W BOCA RATON RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4692
Mailing Address - Country:US
Mailing Address - Phone:623-980-6328
Mailing Address - Fax:
Practice Address - Street 1:7741 W BOCA RATON RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4692
Practice Address - Country:US
Practice Address - Phone:623-980-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA105532355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant