Healthcare Provider Details

I. General information

NPI: 1255266144
Provider Name (Legal Business Name): ANDREA R JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 REDONDO ST
LAS CRUCES NM
88012-0812
US

IV. Provider business mailing address

7100 REDONDO ST
LAS CRUCES NM
88012-0812
US

V. Phone/Fax

Practice location:
  • Phone: 575-650-5529
  • Fax:
Mailing address:
  • Phone: 575-650-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278E1000X
TaxonomyEducational Certified Respiratory Therapist
License Number2272
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: