Provider Demographics
NPI:1326665001
Name:FIMBREZ, VANESA (LAC)
Entity Type:Individual
Prefix:
First Name:VANESA
Middle Name:
Last Name:FIMBREZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 N 2ND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5338
Mailing Address - Country:US
Mailing Address - Phone:408-472-3779
Mailing Address - Fax:
Practice Address - Street 1:1020 SERPENTINE LN STE 115
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4758
Practice Address - Country:US
Practice Address - Phone:925-293-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16254171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist