Healthcare Provider Details

I. General information

NPI: 1952788192
Provider Name (Legal Business Name): KIMBERLEE HURWITZ-PROVDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 MISSION OAKS BLVD BUILDING C
CAMARILLO CA
93012
US

IV. Provider business mailing address

22836 MARGARITA DR
WOODLAND HILLS CA
91364-3843
US

V. Phone/Fax

Practice location:
  • Phone: 310-592-8576
  • Fax:
Mailing address:
  • Phone: 310-592-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: