Provider Demographics
NPI:1811386329
Name:FIMBRES, ROGELIO (MSN/FNP)
Entity Type:Individual
Prefix:MR
First Name:ROGELIO
Middle Name:
Last Name:FIMBRES
Suffix:
Gender:M
Credentials:MSN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 W LEGION RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-7732
Mailing Address - Country:US
Mailing Address - Phone:760-351-4400
Mailing Address - Fax:
Practice Address - Street 1:751 W LEGION RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7732
Practice Address - Country:US
Practice Address - Phone:760-351-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily