Provider Demographics
NPI:1629838362
Name:JIMENEZ-PADILLA, MARIO (MSOP, CP)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:JIMENEZ-PADILLA
Suffix:
Gender:M
Credentials:MSOP, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 E ALLUVIAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2686
Mailing Address - Country:US
Mailing Address - Phone:559-298-0321
Mailing Address - Fax:559-298-7164
Practice Address - Street 1:1247 E ALLUVIAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2686
Practice Address - Country:US
Practice Address - Phone:559-298-0321
Practice Address - Fax:559-298-7164
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist