Healthcare Provider Details

I. General information

NPI: 1073676581
Provider Name (Legal Business Name): KIMBERLY J HOARD NASRUL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N ALTA AVE
DINUBA CA
93618-3205
US

IV. Provider business mailing address

724 N ALTA AVE
DINUBA CA
93618-3205
US

V. Phone/Fax

Practice location:
  • Phone: 559-596-0200
  • Fax: 559-596-0500
Mailing address:
  • Phone: 559-596-0200
  • Fax: 559-596-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number45156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: