MEDICARE: MRS. YARIMAR MARIA SANDOVAL JIMENEZ AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	460	PR

General Provider Information

NPI Number	:	1437134327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YARIMAR MARIA SANDOVAL JIMENEZ AUD

Provider Business Mailing Address
First Line	:	PO BOX 9741
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739-8741
Country	:	US
Telephone Number	:	787-714-1315
Fax Number	:	787-714-1315

Provider Business Practice Location Address
First Line	:	12 CALLE BARCELO
Second Line	:	ESQUINO CARR 173
City	:	CIDRA
State	:	PR
Zip	:	00739-3446
Country	:	US
Telephone Number	:	787-714-1315
Fax Number	:	787-714-1315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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