Provider Demographics
NPI:1760077358
Name:GRIMALDO, JACKELINE
Entity Type:Individual
Prefix:
First Name:JACKELINE
Middle Name:
Last Name:GRIMALDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKELINE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6298 LOCKHILL RD UNIT 1004
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2053
Mailing Address - Country:US
Mailing Address - Phone:210-279-0875
Mailing Address - Fax:210-806-7576
Practice Address - Street 1:6298 LOCKHILL RD UNIT 1004
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2053
Practice Address - Country:US
Practice Address - Phone:210-279-0875
Practice Address - Fax:210-806-7576
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information