Provider Demographics
NPI:1104475417
Name:JIMENEZ, ALONDRA (COTA)
Entity type:Individual
Prefix:MISS
First Name:ALONDRA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:ALONDRA
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:143 EL PASO RD
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6033
Mailing Address - Country:US
Mailing Address - Phone:575-257-2368
Mailing Address - Fax:575-708-2674
Practice Address - Street 1:143 EL PASO RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6033
Practice Address - Country:US
Practice Address - Phone:575-257-2368
Practice Address - Fax:575-708-2674
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant