Individual
WANDA LIZ JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
460 BELMONT ST, BROCKTON, MA 02301-4921
(508) 942-5076
Mailing address
695 N MAIN ST, BROCKTON, MA 02301-2409
(508) 942-5076
(508) 427-0019
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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