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General NPI Number Information
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NPI Number | 1154059574
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Entity Type | Individual
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Provider Name | MONICA ALEXANDRA JIMENEZ VIVES CPHT
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Gender | Female
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | CARR 107 KM 2.7 INT
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-551-3900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250622
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City | AGUADILLA
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State | PR
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Zip | 00604-0622
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Country | US
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Telephone | 787-410-2580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 011583
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License Number State | PR
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