MEDICARE: JACKELINE GRIMALDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Y00000X	Health Information Specialist/Technologist

General Provider Information

NPI Number	:	1760077358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKELINE GRIMALDO

Provider Business Mailing Address
First Line	:	6298 LOCKHILL RD UNIT 1004
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-2053
Country	:	US
Telephone Number	:	210-279-0875
Fax Number	:	210-806-7576

Provider Business Practice Location Address
First Line	:	6298 LOCKHILL RD UNIT 1004
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-2053
Country	:	US
Telephone Number	:	210-279-0875
Fax Number	:	210-806-7576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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Directions to “ JACKELINE GRIMALDO ” Practice Location

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