Provider Demographics
NPI:1699020669
Name:HORTILLOSA, KIMBERLY ANNE ARANETA (LAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY ANNE
Middle Name:ARANETA
Last Name:HORTILLOSA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:HORTILLOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2900 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1504
Mailing Address - Country:US
Mailing Address - Phone:510-390-2204
Mailing Address - Fax:
Practice Address - Street 1:400 29TH ST
Practice Address - Street 2:SUITE 403
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3522
Practice Address - Country:US
Practice Address - Phone:510-390-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14688171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist