1245458132 NPI number — KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.

Table of content: (NPI 1245458132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245458132 NPI number — KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.
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:
Provider Other Organization Name Type Code:
6
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:
1245458132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6757 FRIARS RD UNIT 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108-5013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-298-0169
Provider Business Mailing Address Fax Number:
619-298-0169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 30TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116-4286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-298-2098
Provider Business Practice Location Address Fax Number:
619-298-2098
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORBETT
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
FARA
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
619-298-0169

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY21669 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: MFC39583 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 352923 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7314642 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MFC395830 . This is a "BLUE SHIELD AND TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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