Individual
VANESSA JIMENEZ FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
251 W COLE BLVD, CALEXICO, CA 92231-9722
(760) 357-3768
Mailing address
2680 NANCE RD, IMPERIAL, CA 92251-9605
(760) 679-6259
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA23016
LICENSE
CA
Enumeration date
05/10/2013
Last updated
04/21/2017
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