Jimenez, Wanda

Jimenez, Wanda is an individual health care provider with primary practice located at 1707 Cooks Hill Rd , Centralia WA 98531-9071. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine is her primary health care specialty. Jimenez, Wanda can be contacted via phone (360) 736-1961.

Contact Information

Primary practice address
1707 Cooks Hill Rd Centralia WA 98531-9071
Phone: (360) 736-1961
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine 2083P0901X 175463 New York
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00048802 Washington

Profile Details

NPI number 1306867700
LBN Legal business name Jimenez, Wanda
Credentials M.D.M.P.H
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2006
Last updated Jul 19th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306867700 NPPES
Washington Other 0239255 LABOR & INDUSTRIES
Washington Other 8118JI LABOR & INDUSTRIES
Washington MEDICAID 8530024 LABOR & INDUSTRIES

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