Provider Demographics
NPI:1235597386
Name:WOOLSTENCROFT, KIMBERLY DIANE
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:DIANE
Last Name:WOOLSTENCROFT
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 1:13040 SEILER ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5625
Mailing Address - Country:US
Mailing Address - Phone:760-519-1603
Mailing Address - Fax:
Practice Address - Street 1:13040 SEILER ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5625
Practice Address - Country:US
Practice Address - Phone:760-519-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program