Provider Demographics
NPI:1942515986
Name:KIMBERLY HOTTMANN INCORPORATED
Entity Type:Organization
Organization Name:KIMBERLY HOTTMANN INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOTTMANN-WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:760-436-4050
Mailing Address - Street 1:4836 TWAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4222
Mailing Address - Country:US
Mailing Address - Phone:760-436-4050
Mailing Address - Fax:760-436-9380
Practice Address - Street 1:324 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3723
Practice Address - Country:US
Practice Address - Phone:760-436-4050
Practice Address - Fax:760-436-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15954363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty