Provider Demographics
NPI:1184723009
Name:PIMENTEL, IMELDA P (MD)
Entity type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:P
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3630 N RANCHO DR #104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130
Mailing Address - Country:US
Mailing Address - Phone:702-212-1240
Mailing Address - Fax:702-212-1243
Practice Address - Street 1:3630 N RANCHO DR #104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130
Practice Address - Country:US
Practice Address - Phone:702-212-1240
Practice Address - Fax:702-212-1243
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002814Medicaid