Provider Demographics
NPI:1013128248
Name:JIMENEZ, JACQUELINE (MS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CALLE PALMA REAL
Mailing Address - Street 2:URB. LAS PALMAS
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4416
Mailing Address - Country:US
Mailing Address - Phone:787-877-3698
Mailing Address - Fax:787-877-3698
Practice Address - Street 1:AVE HOSTOS
Practice Address - Street 2:SUITE 15
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-832-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist