Provider Demographics
NPI:1518368703
Name:JIMENEZ, YALIZET
Entity Type:Individual
Prefix:
First Name:YALIZET
Middle Name:
Last Name:JIMENEZ
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 1:279 CALLE 47
Mailing Address - Street 2:VILLAS DE CARRAIZO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:279 CALLE 47
Practice Address - Street 2:VILLAS DE CARRAIZO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9170
Practice Address - Country:US
Practice Address - Phone:787-637-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist