Healthcare Provider Details

I. General information

NPI: 1114894607
Provider Name (Legal Business Name): IRENE PIMENTAL GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N D ST STE 320
SAN BERNARDINO CA
92401-1545
US

IV. Provider business mailing address

330 N D ST STE 320
SAN BERNARDINO CA
92401-1545
US

V. Phone/Fax

Practice location:
  • Phone: 909-893-2782
  • Fax: 909-383-1331
Mailing address:
  • Phone: 909-893-2782
  • Fax: 909-383-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: