Healthcare Provider Details

I. General information

NPI: 1215579602
Provider Name (Legal Business Name): CARLOS E JIMENEZ POZO PMHNP-C, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 W SUNSET RD STE 120
HENDERSON NV
89014-6635
US

IV. Provider business mailing address

1490 W SUNSET RD STE 120
HENDERSON NV
89014-6635
US

V. Phone/Fax

Practice location:
  • Phone: 855-955-5428
  • Fax: 844-389-0835
Mailing address:
  • Phone: 855-955-5428
  • Fax: 844-389-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13033248-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028935
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number826867
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11004595
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13033248-4405
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number321570
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP70043277
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number13033248-4405
License Number StateUT
# 9
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004595
License Number StateFL
# 10
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number826867
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: