Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A7484 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 20A7484 | CA |
NPI | 1346344702 |
---|---|
Provider Name | Mrs. Kimberly Ellen Minesinger |
First Address | Norco, CA 92860-3611 |
Second Address | Corona, CA 92881-3160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H18840 | (02) | CA |