Healthcare Provider Details

I. General information

NPI: 1942991120
Provider Name (Legal Business Name): BROOKE FIMBREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4468 E KINGS CANYON RD BLDG 340
FRESNO CA
93702-3605
US

IV. Provider business mailing address

347 W HERNDON AVE
FRESNO CA
93650-1385
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-6076
  • Fax:
Mailing address:
  • Phone: 559-273-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: