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Individual
MR. MARIO ALFREDO JIMENEZ
Active
Individual
MR. MARIO ALFREDO JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH31058
CA
332B00000X
Durable Medical Equipment & Medical Supplies
0975410001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA358020
—
CA
Enumeration date
09/30/2006
Last updated
12/19/2007
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