Provider Demographics
NPI:1851469688
Name:JIMENEZ BAGUE, CAROL M
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:JIMENEZ BAGUE
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:PO BOX 193069
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3069
Mailing Address - Country:US
Mailing Address - Phone:787-761-0036
Mailing Address - Fax:787-292-5050
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:EDIF ARTURO CADILLA OFIC 205
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-798-5000
Practice Address - Fax:787-292-5050
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0573231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty