Provider Demographics
NPI:1326284571
Name:SHEROW, KIM RENEE
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:RENEE
Last Name:SHEROW
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 1:9150 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2835
Mailing Address - Country:US
Mailing Address - Phone:909-469-4532
Mailing Address - Fax:909-469-9563
Practice Address - Street 1:1660 W MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1200
Practice Address - Country:US
Practice Address - Phone:909-469-4532
Practice Address - Fax:909-469-9563
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M0000XOtherOTHER SERVICE PROVIDERS