Provider Demographics
NPI:1417047960
Name:DONLEY KIMBLE, IRENE (MD)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:DONLEY KIMBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3707
Mailing Address - Country:US
Mailing Address - Phone:909-881-1683
Mailing Address - Fax:909-713-0038
Practice Address - Street 1:249 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3707
Practice Address - Country:US
Practice Address - Phone:909-881-1683
Practice Address - Fax:909-881-4215
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG042558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ11579ZMedicare ID - Type Unspecified
CA00G425580Medicare ID - Type Unspecified
CAA49018Medicare UPIN