Healthcare Provider Details

I. General information

NPI: 1891888111
Provider Name (Legal Business Name): MARIO ALFREDO JIMENEZ PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARIO ALFREDO JIMENEZ PHARM.D.

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 RAMONA BLVD
BALDWIN PARK CA
91706-3241
US

IV. Provider business mailing address

14300 RAMONA BLVD
BALDWIN PARK CA
91706-3241
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-1550
  • Fax: 626-337-0660
Mailing address:
  • Phone: 626-337-1550
  • Fax: 626-337-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH31058
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0975410001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: