1346344702 NPI number — MRS. KIMBERLY ELLEN MINESINGER D.O

Table of content: MRS. KIMBERLY ELLEN MINESINGER D.O (NPI 1346344702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346344702 NPI number — MRS. KIMBERLY ELLEN MINESINGER D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINESINGER
Provider First Name:
KIMBERLY
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1346344702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 TOWN AND COUNTRY DR
Provider Second Line Business Mailing Address:
STE. 104
Provider Business Mailing Address City Name:
NORCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92860-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 FULLERTON AVE STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92881-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-817-5000
Provider Business Practice Location Address Fax Number:
951-817-5002
Provider Enumeration Date:
09/07/2006

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: 207Q00000X , with the licence number:  20A7484 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QH0002X , with the licence number: 20A7484 , 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)





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