Provider Demographics
NPI:1689935629
Name:JIMENEZ, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
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 1:369 E 148TH ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4041
Mailing Address - Country:US
Mailing Address - Phone:718-269-2698
Mailing Address - Fax:718-292-0159
Practice Address - Street 1:369 E 148TH ST
Practice Address - Street 2:BASEMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4041
Practice Address - Country:US
Practice Address - Phone:718-269-2698
Practice Address - Fax:718-292-0159
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16487OtherNYC SERVICE COORDINATION ID