Healthcare Provider Details

I. General information

NPI: 1740673029
Provider Name (Legal Business Name): ALEJANDRO JIMENEZ INCERA AGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10885 S EASTERN AVE SUITE 100
HENDERSON NV
89052-5857
US

IV. Provider business mailing address

4030 S JONES BLVD #32169
LAS VEGAS NV
89173-8801
US

V. Phone/Fax

Practice location:
  • Phone: 702-419-9977
  • Fax: 702-921-0222
Mailing address:
  • Phone: 702-624-5441
  • Fax: 702-921-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN001889
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: