Individual
IVAN JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1817 YAKIMA LN, PUEBLO, CO 81001-1513
(719) 243-6300
Mailing address
1817 YAKIMA LN, PUEBLO, CO 81001-1513
(719) 243-6300
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CO
Other
Enumeration date
10/27/2021
Last updated
10/27/2021
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