Provider Demographics
NPI:1962029793
Name:JIMENEZ, SADIELIS (ND)
Entity Type:Individual
Prefix:DR
First Name:SADIELIS
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 CREST DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5216
Mailing Address - Country:US
Mailing Address - Phone:678-576-2525
Mailing Address - Fax:
Practice Address - Street 1:1207 CARLSBAD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1957
Practice Address - Country:US
Practice Address - Phone:760-736-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1152175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath