Provider Demographics
NPI:1427694306
Name:GOMEZ JIMENEZ, SHELLEY KARUL
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:KARUL
Last Name:GOMEZ 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:P.O.BOX 43002 PMB 261
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-6001
Mailing Address - Country:US
Mailing Address - Phone:787-669-5623
Mailing Address - Fax:
Practice Address - Street 1:CALLE ANTONIO JIMENEZ LANDRAU #90
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-669-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR146491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical