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NPI Code Detail

MEDICARE: DR. KIMBERLY PONTON CROWE MD

MEDICARE: DR. KIMBERLY PONTON CROWE MD
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
12084P0800XPsychiatry PhysicianA105986CA

General Provider Information

NPI Number : 1861639239
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY PONTON CROWE MD
Provider Business Mailing Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1486
Country : US
Telephone Number : 818-996-1051
Fax Number :
Provider Business Practice Location Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1486
Country : US
Telephone Number : 818-996-1051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2009
Last Update Date : 04/01/2025

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