Healthcare Provider Details

I. General information

NPI: 1457862039
Provider Name (Legal Business Name): KIMBERLEE CLEMENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 FIRESTONE BLVD STE 105
DOWNEY CA
90241-4159
US

IV. Provider business mailing address

395 MANILA AVE
LONG BEACH CA
90814-3208
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-5820
  • Fax: 562-684-0102
Mailing address:
  • Phone: 443-340-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number19639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: