Provider Demographics
NPI:1841998325
Name:JIMENEZ, CORALIS
Entity type:Individual
Prefix:
First Name:CORALIS
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORALIS
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:COND. WOODLANDS 921 CARR 876
Mailing Address - Street 2:APT 140
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00976
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COND. WOODLANDS 921 CARR 876
Practice Address - Street 2:APT 140
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00976
Practice Address - Country:UM
Practice Address - Phone:787-478-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6469568OtherASSMCA