Provider Demographics
NPI:1699192195
Name:PAULIEN, KIMBERLY KAYE (MD, RD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAYE
Last Name:PAULIEN
Suffix:
Gender:F
Credentials:MD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25805 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3814
Mailing Address - Country:US
Mailing Address - Phone:909-796-7676
Mailing Address - Fax:
Practice Address - Street 1:25805 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3814
Practice Address - Country:US
Practice Address - Phone:909-796-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01107466133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered