1316456734 NPI number — KIMBERLY ROSE DAVIS MD INC APMC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316456734 NPI number — KIMBERLY ROSE DAVIS MD INC APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBERLY ROSE DAVIS MD INC APMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIMBERLY ROSE DAVIS, MD INC A PROFESSIONAL MEDICAL CORPORATION
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316456734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 SOUTH SIERRA # 1167
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLANA BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92075-2050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-461-9866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2181 CITRACADO PARKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92029-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
442-277-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
858-461-9866

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  A142106 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A142106 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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