=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841998325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORALIS JIMENEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2023
-----------------------------------------------------
Last Update Date | 02/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COND. WOODLANDS 921 CARR 876 APT 140
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PUERTO RICO
-----------------------------------------------------
Zip | 00976
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 787-478-9436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COND. WOODLANDS 921 CARR 876 APT 140
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PUERTO RICO
-----------------------------------------------------
Zip | 00976
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225800000X
-----------------------------------------------------
Taxonomy Name | Recreation Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------