Provider Demographics
NPI:1972967693
Name:JIMENEZ, LISNETTE (MPHE)
Entity Type:Individual
Prefix:MISS
First Name:LISNETTE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MPHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 02 BOCX 7606
Mailing Address - Street 2:OROCOVIS
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-9440
Mailing Address - Country:US
Mailing Address - Phone:787-515-0565
Mailing Address - Fax:
Practice Address - Street 1:HC 02 BOCX 7606
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-9440
Practice Address - Country:US
Practice Address - Phone:787-515-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1002174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator