Healthcare Provider Details

I. General information

NPI: 1962029793
Provider Name (Legal Business Name): SADIELIS JIMENEZ ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 06/27/2020
Certification Date: 06/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 CARLSBAD VILLAGE DR
CARLSBAD CA
92008-1957
US

IV. Provider business mailing address

1988 CREST DR
ENCINITAS CA
92024-5216
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-4444
  • Fax:
Mailing address:
  • Phone: 678-576-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: