1821290917 NPI number — ALFONSO F JIMENEZ

Table of content: (NPI 1821290917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821290917 NPI number — ALFONSO F JIMENEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFONSO F JIMENEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821290917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91-896 MAKULE RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
EWA BEACH
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96706-2543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-689-4414
Provider Business Mailing Address Fax Number:
808-689-7115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91-896 MAKULE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-2543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-689-4414
Provider Business Practice Location Address Fax Number:
808-689-7115
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
ALFONSO
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-689-4414

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H54602 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: H54603 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: H54601 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com