Provider Demographics
NPI:1194540898
Name:GARCIA JIMENEZ, WANDA IWELISSE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:IWELISSE
Last Name:GARCIA 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 1:27 WEST ST APT 8
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2340
Mailing Address - Country:US
Mailing Address - Phone:954-451-7736
Mailing Address - Fax:
Practice Address - Street 1:27 WEST ST APT 8
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2340
Practice Address - Country:US
Practice Address - Phone:954-451-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty