Provider Demographics
NPI:1992914568
Name:JIMENEZ, MARIA M
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:X32 CALLE PENSACOLA
Mailing Address - Street 2:SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4931
Mailing Address - Country:US
Mailing Address - Phone:787-299-9294
Mailing Address - Fax:787-787-4502
Practice Address - Street 1:X32 CALLE PENSACOLA
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4931
Practice Address - Country:US
Practice Address - Phone:787-299-9294
Practice Address - Fax:787-787-4502
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1450183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician