Healthcare Provider Details

I. General information

NPI: 1811386329
Provider Name (Legal Business Name): ROGELIO FIMBRES MSN/FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 W LEGION RD SUITE 103
BRAWLEY CA
92227-7732
US

IV. Provider business mailing address

751 W LEGION RD SUITE 103
BRAWLEY CA
92227-7732
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-4400
  • Fax:
Mailing address:
  • Phone: 760-351-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: