Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A85925 | CA |
NPI | 1982861423 |
---|---|
Provider Name | Dr. Kimberley Kristen Caputo |
First Address | Ventura, CA 93003-7844 |
Second Address | Thousand Oaks, CA 91360-5707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 27/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A85925 | STATE LICENSE (01) | CA |
BC8810168 | DEA (01) | CA |