Basic Information
| Provider Information | |||||||||
| NPI: | 1619180643 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIMENTEL | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 DEL MONTE ST | ||||||||
| Address2: | PO BOX 933 | ||||||||
| City: | MONTAGUE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960649577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304590338 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 444 BRUCE ST | ||||||||
| Address2: | |||||||||
| City: | YREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960973450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308424121 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 352621 | CA | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.