Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 16294 | CA |
NPI | 1659338333 |
---|---|
Provider Name | Ms. Kim Campbell |
First Address | Long Beach, CA 90803-4201 |
Second Address | Long Beach, CA 90803-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |