Healthcare Provider Details

I. General information

NPI: 1487799243
Provider Name (Legal Business Name): CHRISTINA LOUISE FIMBRES R.D.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

2567 PARK BLVD Q-100
PALO ALTO CA
94306-1918
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-849-0537
Mailing address:
  • Phone: 650-321-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: