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General NPI Number Information
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NPI Number | 1770053753
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Entity Type | Individual
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Provider Name | JENNIFER L JIMENEZ RUIZ
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Gender | Female
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | CARR. 417 KM. 0.5 AVE. NATIVO ALERS DESVIO SUR BO. ASOMANTE
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 939-319-5966
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Fax |
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Provider Business Mailing Address
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Address Line | HC 57 BOX 9417
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City | AGUADA
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State | PR
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Zip | 00602-9828
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Country | US
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Telephone | 939-319-5966
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10047
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License Number State | PR
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