Provider Demographics
NPI:1710121777
Name:JIMENEZ, MONICA (MS PHL)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 AVE. HOSTOS SUITE A-31
Mailing Address - Street 2:MEDICAL EMPORIUM II
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-219-0918
Mailing Address - Fax:
Practice Address - Street 1:101 AVE SAN PATRICIO
Practice Address - Street 2:MARAMAR PLAZA ST. 1060
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2645
Practice Address - Country:US
Practice Address - Phone:787-474-0400
Practice Address - Fax:787-474-0408
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist