Provider Demographics
NPI:1184355612
Name:JIMENEZ, LYNOSHKA SHANICE
Entity type:Individual
Prefix:
First Name:LYNOSHKA
Middle Name:SHANICE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 61 BOX 35243
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9404
Mailing Address - Country:US
Mailing Address - Phone:939-366-0360
Mailing Address - Fax:
Practice Address - Street 1:CARR. 417
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9404
Practice Address - Country:US
Practice Address - Phone:939-366-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program