Provider Demographics
NPI:1467479949
Name:BANKS, KIMBERLY CATHERINE (MS)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:CATHERINE
Last Name:BANKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W LA VETA AVE
Mailing Address - Street 2:CANCER GENETICS PROGRAM
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4304
Mailing Address - Country:US
Mailing Address - Phone:714-734-6228
Mailing Address - Fax:714-734-6231
Practice Address - Street 1:1000 W LA VETA AVE
Practice Address - Street 2:CANCER GENETICS PROGRAM
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4304
Practice Address - Country:US
Practice Address - Phone:714-734-6228
Practice Address - Fax:714-734-6231
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2005016170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS