Individual
WANDA IVETTE JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
338 S DAKOTA AVE, VANDENBERG AFB, CA 93437-6307
(805) 606-1721
Mailing address
338 S DAKOTA AVE, VANDENBERG AFB, CA 93437-6307
(805) 606-1721
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
RN9175240
FL
Other
Enumeration date
07/11/2024
Last updated
07/11/2024
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