Healthcare Provider Details

I. General information

NPI: 1689191397
Provider Name (Legal Business Name): DANIEL FIMBRES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E VAN BUREN ST
AVONDALE AZ
85323-1506
US

IV. Provider business mailing address

950 E VAN BUREN ST
AVONDALE AZ
85323-1506
US

V. Phone/Fax

Practice location:
  • Phone: 623-344-6800
  • Fax: 623-344-6801
Mailing address:
  • Phone: 623-344-6800
  • Fax: 623-344-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11221
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: