Healthcare Provider Details

I. General information

NPI: 1952226623
Provider Name (Legal Business Name): YARITZA MICHELLE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #2 KM 29.4
VEGA ALTA PR
00962
US

IV. Provider business mailing address

CARR. #2 KM. 29.4
VEGA ALTA PR
00962
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-1854
  • Fax:
Mailing address:
  • Phone: 787-689-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001420
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: