Healthcare Provider Details

I. General information

NPI: 1679427744
Provider Name (Legal Business Name): KIMBERLY BERUMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15972 TUSCOLA RD STE 103
APPLE VALLEY CA
92307-2106
US

IV. Provider business mailing address

13440 VENTURA BLVD STE 200
SHERMAN OAKS CA
91423-6158
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-3353
  • Fax:
Mailing address:
  • Phone: 818-442-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: