Provider Demographics
NPI:1205248218
Name:POWERS, KIMBERLY AGUPITAN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:AGUPITAN
Last Name:POWERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:BALANGUE
Other - Last Name:AGUPITAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:128 TESORI DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0799
Mailing Address - Country:US
Mailing Address - Phone:909-223-8766
Mailing Address - Fax:
Practice Address - Street 1:44139 MONTEREY AVE STE B
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-8700
Practice Address - Country:US
Practice Address - Phone:760-773-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-24
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656241367500000X
CA95000313367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered