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General NPI Number Information
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NPI Number | 1275455917
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Entity Type | Individual
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Provider Name | LOARISLEIDY JIMENEZ
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Gender | Female
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 1212 AVE AMERICO MIRANDA # 1262
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City | SAN JUAN
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State | PR
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Zip | 00921-1620
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Country | US
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Telephone | 787-783-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 225 GRAND BLVD LOS PRADOS APT 20
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City | CAGUAS
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State | PR
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Zip | 00727-3502
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Country | US
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Telephone | 732-809-1571
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5942
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License Number State | PR
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