Provider Demographics
NPI:1154059574
Name:JIMENEZ VIVES, MONICA ALEXANDRA (CPHT)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:ALEXANDRA
Last Name:JIMENEZ VIVES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250622
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0622
Mailing Address - Country:US
Mailing Address - Phone:787-410-2580
Mailing Address - Fax:
Practice Address - Street 1:CARR 107 KM 2.7 INT
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-551-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011583183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician