Provider Demographics
NPI:1083507479
Name:JIMENEZ, AMANDA ALYSHA R
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALYSHA R
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 1:843 ABRAHAMSON DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9470
Mailing Address - Country:US
Mailing Address - Phone:956-443-9007
Mailing Address - Fax:
Practice Address - Street 1:315 N UTICA DR APT 221
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3034
Practice Address - Country:US
Practice Address - Phone:956-443-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer