Provider Demographics
NPI:1912572967
Name:JIMENEZ CAMPOS, CRISTINA ZULAY
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:ZULAY
Last Name:JIMENEZ CAMPOS
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 1:4515 148TH AVE NE APT JJ103
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3039
Mailing Address - Country:US
Mailing Address - Phone:425-241-0113
Mailing Address - Fax:
Practice Address - Street 1:4515 148TH AVE NE APT JJ103
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3039
Practice Address - Country:US
Practice Address - Phone:425-241-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHM61091679311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home