MEDICARE: MS. KIMBERLEE J KNOX PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA15400	CA

General Provider Information

NPI Number	:	1619974623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLEE J KNOX PA-C

Provider Business Mailing Address
First Line	:	3307 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5703
Country	:	US
Telephone Number	:	619-347-5771
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5703
Country	:	US
Telephone Number	:	619-347-5771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	12/04/2012

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