Individual
ANTHONY JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
349 W 11TH ST, SAN BERNARDINO, CA 92410-3513
(909) 381-3774
Mailing address
1100 N D ST, SAN BERNARDINO, CA 92410-3524
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
692642
CA
Other
Enumeration date
05/18/2022
Last updated
05/18/2022
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