Provider Demographics
NPI:1134765621
Name:JIMENEZ DE RODRIGUEZ, ROSMERY DEL CARMEN
Entity type:Individual
Prefix:MRS
First Name:ROSMERY
Middle Name:DEL CARMEN
Last Name:JIMENEZ DE RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROSMERY
Other - Middle Name:DEL CARMEN
Other - Last Name:JIMENEZ DE RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:165 RUBIL WAY
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4871
Mailing Address - Country:US
Mailing Address - Phone:787-797-1956
Mailing Address - Fax:
Practice Address - Street 1:140 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-7148
Practice Address - Country:US
Practice Address - Phone:706-894-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist