1891496956 NPI number — MRS. KYMBERLY IRENE FRIESEN MA, PSS

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 1891496956 NPI number — MRS. KYMBERLY IRENE FRIESEN MA, PSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIESEN
Provider First Name:
KYMBERLY
Provider Middle Name:
IRENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, PSS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLIVAS
Provider Other First Name:
KYM
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891496956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1519 GREENWICH CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95993-7003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-933-6294
Provider Business Mailing Address Fax Number:
530-645-7532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 GREENWICH CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95993-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-933-6294
Provider Business Practice Location Address Fax Number:
530-645-7532
Provider Enumeration Date:
03/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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