Provider Demographics
NPI:1245837608
Name:ANCIRA, KIMBERLY IRENE (MS, RDN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:IRENE
Last Name:ANCIRA
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 ACORN PL
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-8681
Mailing Address - Country:US
Mailing Address - Phone:925-784-9317
Mailing Address - Fax:
Practice Address - Street 1:366 ACORN PL
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-8681
Practice Address - Country:US
Practice Address - Phone:925-784-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1006606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered