=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174492094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAOLO DE CASTRO JIMENO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2025
-----------------------------------------------------
Last Update Date | 10/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1380 HOWARD ST # 130
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94103-2638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 628-754-9110
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 IDLEWILD CT
-----------------------------------------------------
City | PACIFICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94044-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | TCH172934
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------