Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC29152 | CA |
N | 111NN1001X | Nutrition | DC29152 | CA |
NPI | 1619073277 |
---|---|
Provider Name | Dr. Kimberly Didomenicantonio |
First Address | Torrance, CA 90505-6658 |
Second Address | Torrance, CA 90505-6658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |