Healthcare Provider Details

I. General information

NPI: 1003518937
Provider Name (Legal Business Name): VANESSA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 BRETON RIDGE ST # A&H
HOUSTON TX
77070-6081
US

IV. Provider business mailing address

13307 BAYONNE CIR
TOMBALL TX
77377-7254
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number1016373
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: