Provider Demographics
NPI:1659504447
Name:PIMENTEL, JERRY WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:WILLIAM
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:220 STANDIFORD AVE
Mailing Address - Street 2:STE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1159
Mailing Address - Country:US
Mailing Address - Phone:209-661-4335
Mailing Address - Fax:209-579-5637
Practice Address - Street 1:2150 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2003
Practice Address - Country:US
Practice Address - Phone:209-656-0183
Practice Address - Fax:209-656-0199
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2021-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant