Provider Demographics
NPI:1356121958
Name:FIMBRES, KRISTAN (AUD)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:FIMBRES
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ROSE AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:805-983-4212
Practice Address - Street 1:1700 N ROSE AVE STE 460
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7629
Practice Address - Country:US
Practice Address - Phone:805-983-4214
Practice Address - Fax:805-983-4212
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3825231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist