Healthcare Provider Details

I. General information

NPI: 1043702160
Provider Name (Legal Business Name): KIMBERLY YOMAYRA HULLOA CASILLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE STE 200
BAKERSFIELD CA
93301-3143
US

IV. Provider business mailing address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8321
  • Fax:
Mailing address:
  • Phone: 661-635-2941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: