Provider Demographics
NPI:1760652820
Name:CARDOSO, KIMBERLY H (CNM, NP, MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:CARDOSO
Suffix:
Gender:F
Credentials:CNM, NP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 VALLE VISTA AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610
Mailing Address - Country:US
Mailing Address - Phone:510-204-4666
Mailing Address - Fax:
Practice Address - Street 1:2001 DWIGHT WAY
Practice Address - Street 2:SUITE 1363
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-4666
Practice Address - Fax:510-204-5304
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524159163W00000X, 363L00000X, 367A00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife