Healthcare Provider Details

I. General information

NPI: 1306225297
Provider Name (Legal Business Name): ABRAHAM PIMENTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 05/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PEAK VILLA AVE
NORTH LAS VEGAS NV
89031-1390
US

IV. Provider business mailing address

13 PEAK VILLA AVE
NORTH LAS VEGAS NV
89031-1390
US

V. Phone/Fax

Practice location:
  • Phone: 702-579-9510
  • Fax:
Mailing address:
  • Phone: 702-579-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License NumberRC1618
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number009787
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: