Healthcare Provider Details

I. General information

NPI: 1528576808
Provider Name (Legal Business Name): ANNETTE YANIRA JIMENEZ-COLLET MSCEX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2018
Last Update Date: 01/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ESTANCIAS DE BORINQUEN CASA 21
MANATI PR
00674-4880
US

IV. Provider business mailing address

95 ESTANCIAS DE BORINQUEN
MANATI PR
00674-4880
US

V. Phone/Fax

Practice location:
  • Phone: 787-599-7273
  • Fax:
Mailing address:
  • Phone: 787-599-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUPRRP2018
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License NumberUPRRP2018
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2218407
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerDRIVERS LICENSE ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: