Provider Demographics
NPI:1053128173
Name:JAIMES, FIDENCIO JR
Entity type:Individual
Prefix:
First Name:FIDENCIO
Middle Name:
Last Name:JAIMES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 1/2 DORIS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-8628
Mailing Address - Country:US
Mailing Address - Phone:970-902-3451
Mailing Address - Fax:
Practice Address - Street 1:442 1/2 DORIS RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-8628
Practice Address - Country:US
Practice Address - Phone:970-902-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist