Healthcare Provider Details

I. General information

NPI: 1336623214
Provider Name (Legal Business Name): VANESSA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 INFANTERIA AVE CARR 3 KM 9.5 REPARTO INDUSTRIAL SAN GABRIEL
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 89
SAINT JUST PR
00978-0089
US

V. Phone/Fax

Practice location:
  • Phone: 787-620-2900
  • Fax:
Mailing address:
  • Phone: 787-602-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4826
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: