Provider Demographics
NPI:1225319478
Name:PIMENTEL, FRANCISCO T (PTA)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:T
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 HEFFERNAN AVE
Mailing Address - Street 2:STE 2-B
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4718
Mailing Address - Country:US
Mailing Address - Phone:760-768-4100
Mailing Address - Fax:760-768-6900
Practice Address - Street 1:420 HEFFERNAN AVE
Practice Address - Street 2:STE 2-B
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4718
Practice Address - Country:US
Practice Address - Phone:760-768-4100
Practice Address - Fax:760-768-6900
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT 3780OtherSTATE OF CALIFORNIA