Provider Demographics
NPI:1477688059
Name:NAVARRO, KIMBERLY ANN (MASTERS OF SCIENCE I)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MASTERS OF SCIENCE I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10452 WHIRLAWAY ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4466
Mailing Address - Country:US
Mailing Address - Phone:949-929-7170
Mailing Address - Fax:714-723-0487
Practice Address - Street 1:10452 WHIRLAWAY ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4466
Practice Address - Country:US
Practice Address - Phone:949-929-7170
Practice Address - Fax:714-723-0487
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42688106H00000X
CALIC# 42686106H00000X
CAMFC42686106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist