Provider Demographics
NPI:1477861458
Name:REYNOLDS, KIMBERLY (RN, LAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 OBERLIN DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3703
Mailing Address - Country:US
Mailing Address - Phone:858-335-8024
Mailing Address - Fax:
Practice Address - Street 1:5830 OBERLIN DR
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3703
Practice Address - Country:US
Practice Address - Phone:858-335-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA662500163W00000X
CA13798171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse