Healthcare Provider Details

I. General information

NPI: 1326665001
Provider Name (Legal Business Name): VANESA FIMBREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 NE EVANS ST
MCMINNVILLE OR
97128-3923
US

IV. Provider business mailing address

91177 MAYOR CT
COBURG OR
97408-9349
US

V. Phone/Fax

Practice location:
  • Phone: 408-472-3779
  • Fax:
Mailing address:
  • Phone: 408-472-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: