Healthcare Provider Details

I. General information

NPI: 1740724798
Provider Name (Legal Business Name): CARMEN JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2016
Last Update Date: 12/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ERIE CIR
NASHUA NH
03062-3550
US

IV. Provider business mailing address

22 ERIE CIR
NASHUA NH
03062-3550
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-5285
  • Fax:
Mailing address:
  • Phone: 561-900-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: