Provider Demographics
NPI:1255467916
Name:TAYLOR, KIMBERLEY JEAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 2ND ST # 365
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5008
Mailing Address - Country:US
Mailing Address - Phone:760-291-7025
Mailing Address - Fax:
Practice Address - Street 1:543 ENCINITAS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3744
Practice Address - Country:US
Practice Address - Phone:760-291-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10085171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist