Healthcare Provider Details

I. General information

NPI: 1992914568
Provider Name (Legal Business Name): MARIA M JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

X32 CALLE PENSACOLA SANTA JUANITA
BAYAMON PR
00956-4931
US

IV. Provider business mailing address

X32 CALLE PENSACOLA SANTA JUANITA
BAYAMON PR
00956-4931
US

V. Phone/Fax

Practice location:
  • Phone: 787-299-9294
  • Fax: 787-787-4502
Mailing address:
  • Phone: 787-299-9294
  • Fax: 787-787-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1450
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: