Provider Demographics
NPI:1700948338
Name:KIRBY, KATHRYN W (MED)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:W
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 CAMINITO DEL OESTE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6874
Mailing Address - Country:US
Mailing Address - Phone:858-650-3563
Mailing Address - Fax:
Practice Address - Street 1:4295 GESNER ST
Practice Address - Street 2:SUITE 2H
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6646
Practice Address - Country:US
Practice Address - Phone:619-276-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist