Healthcare Provider Details

I. General information

NPI: 1376116137
Provider Name (Legal Business Name): MR. ADOLFO JAIMES I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24011 RICHARDS RD APT 1612
SPRING TX
77386-3277
US

IV. Provider business mailing address

24011 RICHARDS RD APT 1612
SPRING TX
77386-3277
US

V. Phone/Fax

Practice location:
  • Phone: 936-286-0912
  • Fax:
Mailing address:
  • Phone: 936-286-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: