Provider Demographics
NPI:1053196667
Name:JIMENEZ, CRISTINA ANGELICA (AUD)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ANGELICA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 S SPRAGUE CT
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6903
Mailing Address - Country:US
Mailing Address - Phone:800-586-4779
Mailing Address - Fax:
Practice Address - Street 1:5821 S SPRAGUE CT
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6903
Practice Address - Country:US
Practice Address - Phone:800-586-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61478495231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist