MEDICARE: KIMBERLY GABRIELLA LOW MFTI

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	106H00000X	Marriage & Family Therapist	47206	CA

General Provider Information

NPI Number	:	1841485398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY GABRIELLA LOW MFTI

Provider Business Mailing Address
First Line	:	2452 OAK ST
Second Line	:	D
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5192
Country	:	US
Telephone Number	:	415-810-2594
Fax Number	:

Provider Business Practice Location Address
First Line	:	2452 OAK ST
Second Line	:	D
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5192
Country	:	US
Telephone Number	:	415-810-2594
Fax Number	:

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

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	10/05/2015

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