Provider Demographics
NPI:1689103822
Name:JIMENEZ GUZMAN, YANEIRA (SA-C)
Entity Type:Individual
Prefix:
First Name:YANEIRA
Middle Name:
Last Name:JIMENEZ GUZMAN
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 SPRING DAY CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8926
Mailing Address - Country:US
Mailing Address - Phone:832-829-1473
Mailing Address - Fax:
Practice Address - Street 1:2503 SPRING DAY CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-8926
Practice Address - Country:US
Practice Address - Phone:832-829-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-467246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant