Provider Demographics
NPI:1124335732
Name:PIMENTEL, RENEE M (NP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SPERRY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9297
Mailing Address - Country:US
Mailing Address - Phone:209-892-3111
Mailing Address - Fax:209-892-3112
Practice Address - Street 1:1010 SPERRY AVE STE D
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9297
Practice Address - Country:US
Practice Address - Phone:209-892-3111
Practice Address - Fax:209-892-3112
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19156363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty