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General NPI Number Information
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NPI Number | 1063811727
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Entity Type | Individual
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Provider Name | TAINA JIMENEZ-LOPEZ M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 862 CALLE ESTEBAN GONZALEZ CONDOMINIO UNIVERSITARIO APTO. 10B
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City | SAN JUAN
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State | PR
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Zip | 00925-2309
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Country | US
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Telephone | 787-508-8984
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Fax |
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Provider Business Mailing Address
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Address Line | 862 CALLE ESTEBAN GONZALEZ CONDOMINIO UNIVERSITARIO APTO. 10B
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City | SAN JUAN
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State | PR
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Zip | 00925-2309
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Country | US
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Telephone | 787-508-8984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 974
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8339
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License Number State | MA
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