Provider Demographics
NPI:1063811727
Name:JIMENEZ-LOPEZ, TAINA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TAINA
Middle Name:
Last Name:JIMENEZ-LOPEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 CALLE ESTEBAN GONZALEZ
Mailing Address - Street 2:CONDOMINIO UNIVERSITARIO APTO. 10B
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2309
Mailing Address - Country:US
Mailing Address - Phone:787-508-8984
Mailing Address - Fax:
Practice Address - Street 1:862 CALLE ESTEBAN GONZALEZ
Practice Address - Street 2:CONDOMINIO UNIVERSITARIO APTO. 10B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2309
Practice Address - Country:US
Practice Address - Phone:787-508-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR974235Z00000X
MA8339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist