Provider Demographics
NPI:1982094314
Name:KIMP, NYDIA SANCHEZ
Entity Type:Individual
Prefix:MS
First Name:NYDIA
Middle Name:SANCHEZ
Last Name:KIMP
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 1:15530 TUBA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2617
Mailing Address - Country:US
Mailing Address - Phone:818-471-8488
Mailing Address - Fax:
Practice Address - Street 1:15530 TUBA ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2617
Practice Address - Country:US
Practice Address - Phone:818-471-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1529271347C00000X
CAB6746157347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle