Healthcare Provider Details

I. General information

NPI: 1811021587
Provider Name (Legal Business Name): MR. JEFF K. FIMBREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 N MARKS AVE SUITE 104
FRESNO CA
93711-0288
US

IV. Provider business mailing address

1951 TRUMAN DR
MADERA CA
93638-1795
US

V. Phone/Fax

Practice location:
  • Phone: 559-446-3000
  • Fax: 559-248-8555
Mailing address:
  • Phone: 559-970-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: