Provider Demographics
NPI:1497211031
Name:JIMENEZ, NEPHTALI (MA, SLP-CF)
Entity Type:Individual
Prefix:
First Name:NEPHTALI
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MA, SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19950 HUEBNER RD APT 1017
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3297
Mailing Address - Country:US
Mailing Address - Phone:915-422-5070
Mailing Address - Fax:
Practice Address - Street 1:22211 IH 10 W STE 1206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1742
Practice Address - Country:US
Practice Address - Phone:210-888-0368
Practice Address - Fax:888-506-2346
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist