Provider Demographics
NPI:1538360474
Name:JIMENEZ, KRISTINA MARIE (LMT)
Entity type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:MARIE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14242 E BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-5904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 S POWER RD
Practice Address - Street 2:STE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5207
Practice Address - Country:US
Practice Address - Phone:480-641-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist