Provider Demographics
NPI:1942044151
Name:JIMENEZ SANTIAGO, GLORIMELL (MAESTRIA)
Entity type:Individual
Prefix:
First Name:GLORIMELL
Middle Name:
Last Name:JIMENEZ SANTIAGO
Suffix:
Gender:F
Credentials:MAESTRIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 3673
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-9697
Mailing Address - Country:US
Mailing Address - Phone:939-241-6991
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 3673
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-9697
Practice Address - Country:US
Practice Address - Phone:939-241-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40362355S0801X
PR007965103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant