Provider Demographics
NPI:1245794288
Name:JIMENEZ, VALERIA ALEJANDRA (PHARM D)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:ALEJANDRA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2911
Mailing Address - Country:US
Mailing Address - Phone:714-399-5880
Mailing Address - Fax:
Practice Address - Street 1:9256 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4526
Practice Address - Country:US
Practice Address - Phone:562-949-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist