Provider Demographics
NPI:1659995827
Name:JIMENEZ, JOSHUA RYAN
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:RYAN
Other - Last Name:JIMENEZ-SHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:6011 COUNTY ROAD 516
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122
Mailing Address - Country:US
Mailing Address - Phone:303-304-7205
Mailing Address - Fax:
Practice Address - Street 1:6011 COUNTY ROAD 516
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122
Practice Address - Country:US
Practice Address - Phone:303-304-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist