Provider Demographics
NPI:1952152019
Name:GONZALEZ JIMENEZ, KARISSA FRANCHESKA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:FRANCHESKA
Last Name:GONZALEZ JIMENEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 10126
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-7417
Mailing Address - Country:US
Mailing Address - Phone:787-859-7959
Mailing Address - Fax:
Practice Address - Street 1:CARR 159 KM 8.4
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist