Provider Demographics
NPI:1780869180
Name:DUKES-SAMALA, KIIMBERLEE KATHERENE
Entity type:Individual
Prefix:MRS
First Name:KIIMBERLEE
Middle Name:KATHERENE
Last Name:DUKES-SAMALA
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 1:1129 MELIA PL
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5263
Mailing Address - Country:US
Mailing Address - Phone:714-680-9000
Mailing Address - Fax:
Practice Address - Street 1:801 E CHAPMAN AVE STE 230
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3847
Practice Address - Country:US
Practice Address - Phone:714-680-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator