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Organization

ALFONSO F JIMENEZ

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALFONSO F JIMENEZ D.O. (OWNER)
(808) 689-4414
Entity
Organization

Contact information

Practice address
91-896 MAKULE RD, SUITE 102, EWA BEACH, HI 96706-2543
(808) 689-4414
(808) 689-7115
Mailing address
91-896 MAKULE RD, SUITE 102, EWA BEACH, HI 96706-2543
(808) 689-4414
(808) 689-7115

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
H54601
MEDICARE PROVIDER NUMBER
HI
01
H54602
MEDICARE PROVIDER NUMBER
HI
01
H54603
MEDICARE PROVIDER NUMBER
HI
Enumeration date
06/01/2007
Last updated
08/26/2008
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