Provider Demographics
NPI:1558655332
Name:JIMENEZ, CRISTINE RENEE
Entity Type:Individual
Prefix:MS
First Name:CRISTINE
Middle Name:RENEE
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 1:1705 SW 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1012
Mailing Address - Country:US
Mailing Address - Phone:786-546-9125
Mailing Address - Fax:
Practice Address - Street 1:6447 MIAMI LAKES DRIVE EAST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-556-2225
Practice Address - Fax:305-556-2229
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant