Provider Demographics
NPI:1982353348
Name:JIMENEZ, ZAYRO DAFNE (MC)
Entity Type:Individual
Prefix:
First Name:ZAYRO
Middle Name:DAFNE
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 E INDIAN SCHOOL RD STE 1005
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5469
Mailing Address - Country:US
Mailing Address - Phone:623-404-1821
Mailing Address - Fax:
Practice Address - Street 1:6125 E INDIAN SCHOOL RD STE 1005
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5469
Practice Address - Country:US
Practice Address - Phone:480-801-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC-19361101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor