Healthcare Provider Details

I. General information

NPI: 1013865484
Provider Name (Legal Business Name): KIMBERLY JENNISE SOLARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 SAN FERNANDO MISSION BLVD APT 58
GRANADA HILLS CA
91344-4216
US

IV. Provider business mailing address

16600 SAN FERNANDO MISSION BLVD APT 58
GRANADA HILLS CA
91344-4216
US

V. Phone/Fax

Practice location:
  • Phone: 661-481-0022
  • Fax:
Mailing address:
  • Phone: 661-481-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: