Individual
EDGAR JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2860 E FLAMINGO RD STE K, LAS VEGAS, NV 89121-5270
(702) 318-5005
Mailing address
2001 S JONES BLVD, STE E3, LAS VEGAS, NV 89146-3182
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
1017014744001
NV
253Z00000X
In Home Supportive Care Agency
Primary
1710058573
NV
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710058573
PERSONAL CARE
NV
05
—
1710058573
—
NV
Enumeration date
06/22/2015
Last updated
03/17/2018
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