Individual
DR. WANDA JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.M.P.H
Contact information
Practice address
1707 COOKS HILL RD, CENTRALIA, WA 98531-9071
(360) 736-1961
Mailing address
1707 COOKS HILL RD, CENTRALIA, WA 98531-9071
(360) 736-1965
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD00048802
WA
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
175463
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0239255
LABOR & INDUSTRIES
WA
01
—
8118JI
REGENCE
—
05
—
8530024
—
WA
Enumeration date
07/21/2006
Last updated
07/19/2010
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