Individual
THEODORE JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1650 COCHRANE CIR UNIT MEDDAC, FORT CARSON, CO 80913-4604
(719) 526-7422
Mailing address
1650 COCHRANE CIR UNIT MEDDAC, FORT CARSON, CO 80913-4604
(719) 526-7422
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.0333204
CO
Other
Enumeration date
02/04/2021
Last updated
02/04/2021
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