1932903226 NPI number — KIMBERLY ASHLEY SERRANO CHAVEZ

Table of content: KIMBERLY ASHLEY SERRANO CHAVEZ (NPI 1932903226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932903226 NPI number — KIMBERLY ASHLEY SERRANO CHAVEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERRANO CHAVEZ
Provider First Name:
KIMBERLY
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1932903226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 SCHAFFER RD
Provider Second Line Business Mailing Address:
BD 1 SUITE 1A
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-420-0120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 SCHAFFER RD
Provider Second Line Business Practice Location Address:
BD 1 SUITE 1A
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-420-0120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2025

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: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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