Provider Demographics
NPI:1770867319
Name:FIMBRES, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:FIMBRES
Suffix:
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 1:5793 DUVAL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-6876
Mailing Address - Country:US
Mailing Address - Phone:702-666-7528
Mailing Address - Fax:
Practice Address - Street 1:4955 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0152
Practice Address - Country:US
Practice Address - Phone:702-650-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation