Healthcare Provider Details

I. General information

NPI: 1982242244
Provider Name (Legal Business Name): AARON JIMENEZ DUQUE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 BOSWELL RD
CHULA VISTA CA
91914-3509
US

IV. Provider business mailing address

911 VIA VERDE
CHULA VISTA CA
91910-7025
US

V. Phone/Fax

Practice location:
  • Phone: 619-397-0939
  • Fax: 619-421-4907
Mailing address:
  • Phone: 619-502-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95070652
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number95070652
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number95070652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: