Provider Demographics
NPI:1619644127
Name:CURTIS, KIEARA MARIE
Entity Type:Individual
Prefix:
First Name:KIEARA
Middle Name:MARIE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 BRIARWOOD RD UNIT J13
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1825
Mailing Address - Country:US
Mailing Address - Phone:619-857-6336
Mailing Address - Fax:
Practice Address - Street 1:1461 LOUDEN LN
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-3244
Practice Address - Country:US
Practice Address - Phone:619-952-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD4755344OtherDRIVER LICENSE