Provider Demographics
NPI:1356183859
Name:O'NEILL, KIMBERLEY ANNE
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 S CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-1852
Mailing Address - Country:US
Mailing Address - Phone:562-209-3278
Mailing Address - Fax:
Practice Address - Street 1:1101 CALIFORNIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6473
Practice Address - Country:US
Practice Address - Phone:951-900-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty