Individual
MR. JIMMY MACK IM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4938 N MUSCATEL AVE, SAN GABRIEL, CA 91776-2142
(626) 228-9201
Mailing address
4938 N MUSCATEL AVE, SAN GABRIEL, CA 91776-2142
(626) 228-9201
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
292252
CA
Other
Enumeration date
11/16/2015
Last updated
11/16/2015
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