Provider Demographics
NPI:1356479752
Name:CARDILLO, KIMBERLY GARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:GARCIA
Last Name:CARDILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13031 VILLOSA PL APT 409
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-6503
Mailing Address - Country:US
Mailing Address - Phone:909-534-4632
Mailing Address - Fax:
Practice Address - Street 1:13031 VILLOSA PL APT 409
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-6503
Practice Address - Country:US
Practice Address - Phone:909-534-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA897572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry