Provider Demographics
NPI:1932749439
Name:JIMENEZ, MARITZA (RPH)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GUAYACAN 2
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-231-5590
Mailing Address - Fax:787-256-0069
Practice Address - Street 1:CARR 188 KM 1.5 BO SAN ISIDRO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-957-2051
Practice Address - Fax:787-256-0069
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR50891835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care