Provider Demographics
NPI:1326719824
Name:COBARRUVIAS, KIMBERLEE LYNNE
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:LYNNE
Last Name:COBARRUVIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:LYNNE
Other - Last Name:ESSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA EDUCATION TECH
Mailing Address - Street 1:114 E SHAW AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7621
Mailing Address - Country:US
Mailing Address - Phone:559-243-7002
Mailing Address - Fax:
Practice Address - Street 1:1788 CELESTE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-2069
Practice Address - Country:US
Practice Address - Phone:559-297-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator