Provider Demographics
NPI:1700923133
Name:DAVIS, KIMBERLY LIMYOU (LVN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LIMYOU
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 ATLANTA AVE
Mailing Address - Street 2:D3
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1827 ATLANTA AVE
Practice Address - Street 2:D3
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7419
Practice Address - Country:US
Practice Address - Phone:951-955-8000
Practice Address - Fax:951-955-8010
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219798164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse