Provider Demographics
NPI:1922664846
Name:JIMENEZ FERNANDEZ, CASSANDRA LIZ (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LIZ
Last Name:JIMENEZ FERNANDEZ
Suffix:
Gender:F
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:IJ22 CALLE PALMA REAL
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-2970
Mailing Address - Country:US
Mailing Address - Phone:787-449-7885
Mailing Address - Fax:
Practice Address - Street 1:IJ22 CALLE PALMA REAL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2970
Practice Address - Country:US
Practice Address - Phone:787-449-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR675111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty