Provider Demographics
NPI:1255676359
Name:FIMBREZ, ROXANNA
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:FIMBREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXANNA
Other - Middle Name:
Other - Last Name:AGUILERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25042
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 E BARSTOW AVE STE 135
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5025
Practice Address - Country:US
Practice Address - Phone:559-930-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1118172103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst