Provider Demographics
NPI:1851525182
Name:KANDARIAN, KIMBERLY (FNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:KANDARIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 KINGSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-3730
Mailing Address - Country:US
Mailing Address - Phone:805-985-2640
Mailing Address - Fax:
Practice Address - Street 1:2120 KINGSBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-3730
Practice Address - Country:US
Practice Address - Phone:805-985-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily