Healthcare Provider Details

I. General information

NPI: 1154482446
Provider Name (Legal Business Name): KIMBERLY MARIE KAUFFMAN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON BLDG H100 SANTA MARGARITA
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

3635 3RD AVE UNIT 1
SAN DIEGO CA
92103-4143
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1244
  • Fax:
Mailing address:
  • Phone: 440-309-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number721218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: