Provider Demographics
NPI:1780285809
Name:LOVE, KIMBERLEY (ND)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8727
Mailing Address - Country:US
Mailing Address - Phone:760-429-9657
Mailing Address - Fax:
Practice Address - Street 1:1757 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8727
Practice Address - Country:US
Practice Address - Phone:760-429-9657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1147175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath