Provider Demographics
NPI:1730564170
Name:JIMENEZ, MARIA DOLORES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
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 1:9024 ORANGE BLOSSOM LOOP
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6386
Mailing Address - Country:US
Mailing Address - Phone:321-315-7640
Mailing Address - Fax:
Practice Address - Street 1:9024 ORANGE BLOSSOM LOOP
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844
Practice Address - Country:US
Practice Address - Phone:321-315-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker