Provider Demographics
NPI:1568895753
Name:BALESTERI, KIMBERLY (HHP, CHT, CST)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BALESTERI
Suffix:
Gender:F
Credentials:HHP, CHT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 GLENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-4053
Mailing Address - Country:US
Mailing Address - Phone:619-203-2682
Mailing Address - Fax:
Practice Address - Street 1:1130 CAMINO DEL MAR STE G1
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2639
Practice Address - Country:US
Practice Address - Phone:619-203-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CA552640-08225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula