Provider Demographics
NPI:1487709648
Name:SANTISTEBAN JIMENEZ, INGRID (SLP)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:SANTISTEBAN JIMENEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FF3 CALLE POPPY
Mailing Address - Street 2:BORINQUEN GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6401
Mailing Address - Country:US
Mailing Address - Phone:787-562-6710
Mailing Address - Fax:
Practice Address - Street 1:FF3 CALLE POPPY
Practice Address - Street 2:BORINQUEN GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6401
Practice Address - Country:US
Practice Address - Phone:787-562-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist