Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 41461 | CA |
NPI | 1063179380 |
---|---|
Provider Name | Kimberly S Acosta |
First Address | Woonsocket, RI 02895 |
Second Address | Montebello, CA 90640-1806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2021 |
Last Update Date | 22/11/2021 |