Provider Demographics
NPI:1649838582
Name:JIMENEZ, JUAN RAMON (PHARMD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:RAMON
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7147
Mailing Address - Country:US
Mailing Address - Phone:559-734-5861
Mailing Address - Fax:559-734-5632
Practice Address - Street 1:3010 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7147
Practice Address - Country:US
Practice Address - Phone:559-734-5861
Practice Address - Fax:559-734-5632
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist