Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | A43877 | CA |
NPI | 1003926882 |
---|---|
Provider Name | Ms. Kimberly Anne Shriner |
First Address | Brea, CA 92822-1449 |
Second Address | Pasadena, CA 91105-3149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 07/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A438770 | (05) | CA |
00A438770 | BLUE SHIELD (01) | CA |
110025943 | RAILROAD RETIREMENT (01) | GA |
E83303 | (02) |