Provider Demographics
NPI:1942650841
Name:FIMBRES, MARCO
Entity Type:Individual
Prefix:
First Name:MARCO
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 1:595 LINCOLNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-3370
Mailing Address - Country:US
Mailing Address - Phone:562-334-7843
Mailing Address - Fax:
Practice Address - Street 1:11517 15TH AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9508
Practice Address - Country:US
Practice Address - Phone:559-530-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility