Provider Demographics
NPI:1184350712
Name:TIMPERLAKE-OLIVARES, KIMBERLY A (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:TIMPERLAKE-OLIVARES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ABBOTT ST STE C
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4486
Mailing Address - Country:US
Mailing Address - Phone:831-288-8811
Mailing Address - Fax:831-998-7809
Practice Address - Street 1:333 ABBOTT ST STE C
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4486
Practice Address - Country:US
Practice Address - Phone:831-288-8811
Practice Address - Fax:831-998-7809
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics