Provider Demographics
NPI:1215579602
Name:JIMENEZ POZO, CARLOS E (NP)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:E
Last Name:JIMENEZ POZO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 STERLING CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-1739
Mailing Address - Country:US
Mailing Address - Phone:252-274-5197
Mailing Address - Fax:725-215-9309
Practice Address - Street 1:348 N NELLIS BLVD STE F
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5313
Practice Address - Country:US
Practice Address - Phone:702-508-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13033248-4405363LF0000X, 363LP2300X
FL11004595363LF0000X
NV826867363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care