Provider Demographics
NPI:1780394239
Name:JIMENEZ, ALVARO (RN)
Entity type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-3493
Mailing Address - Country:US
Mailing Address - Phone:760-979-3330
Mailing Address - Fax:
Practice Address - Street 1:1165 PECAN ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-3493
Practice Address - Country:US
Practice Address - Phone:760-979-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA737465163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse