Healthcare Provider Details

I. General information

NPI: 1093398505
Provider Name (Legal Business Name): JENNIFFER ALEXANDRA MEZA JIMENEZ LD/N, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 03/05/2022
Certification Date: 03/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 45TH ST
WEST PALM BEACH FL
33407-2361
US

IV. Provider business mailing address

1150 45TH ST
WEST PALM BEACH FL
33407-2361
US

V. Phone/Fax

Practice location:
  • Phone: 561-506-5693
  • Fax:
Mailing address:
  • Phone: 561-506-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number324440
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND9639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: