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General NPI Number Information
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NPI Number | 1164987657
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Entity Type | Individual
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Provider Name | KATHERINE MICHELLE JIMENEZ
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Gender | Female
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 2431 NE 8TH TER
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6461
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Country | US
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Telephone | 954-348-0988
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 NE 8TH TER
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6461
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Country | US
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Telephone | 954-348-0988
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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