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General NPI Number Information
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NPI Number | 1871975219
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Entity Type | Individual
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Provider Name | EDGAR JIMENEZ
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Gender | Male
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2860 E FLAMINGO RD STE K
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City | LAS VEGAS
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State | NV
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Zip | 89121-5270
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Country | US
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Telephone | 702-318-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 S JONES BLVD STE E3
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City | LAS VEGAS
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State | NV
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Zip | 89146-3182
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1017014744001
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1710058573
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License Number State | NV
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