Provider Demographics
NPI:1043721046
Name:NEVAREZ, KIMBERLY E
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 S LA CIENEGA BLVD BLDG SUITE208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2591
Mailing Address - Country:US
Mailing Address - Phone:323-426-6402
Mailing Address - Fax:
Practice Address - Street 1:410 E MERCED AVE SUITE D
Practice Address - Street 2:SUITE D
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:661-480-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45222355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant