Provider Demographics
NPI:1528576808
Name:JIMENEZ-COLLET, ANNETTE YANIRA (MSCEX)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:YANIRA
Last Name:JIMENEZ-COLLET
Suffix:
Gender:F
Credentials:MSCEX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ESTANCIAS DE BORINQUEN
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4880
Mailing Address - Country:US
Mailing Address - Phone:787-599-7273
Mailing Address - Fax:
Practice Address - Street 1:95 ESTANCIAS DE BORINQUEN
Practice Address - Street 2:CASA 21
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4880
Practice Address - Country:US
Practice Address - Phone:787-599-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRUPRRP2018390200000X, 224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2218407OtherDRIVERS LICENSE ID