Provider Demographics
NPI:1063804672
Name:ERIVEZ, JIMMY
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:ERIVEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 S NEW RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1335
Mailing Address - Country:US
Mailing Address - Phone:254-537-4422
Mailing Address - Fax:254-300-4619
Practice Address - Street 1:750 SUNLAND PARK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6709
Practice Address - Country:US
Practice Address - Phone:915-760-8830
Practice Address - Fax:915-760-8840
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80268237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist