Healthcare Provider Details

I. General information

NPI: 1124335732
Provider Name (Legal Business Name): RENEE M. PIMENTEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SPERRY AVE STE D
PATTERSON CA
95363-9297
US

IV. Provider business mailing address

1010 SPERRY AVE STE D
PATTERSON CA
95363-9297
US

V. Phone/Fax

Practice location:
  • Phone: 209-892-3111
  • Fax: 209-892-3112
Mailing address:
  • Phone: 209-892-3111
  • Fax: 209-892-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19156
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: