Healthcare Provider Details

I. General information

NPI: 1801830070
Provider Name (Legal Business Name): KIMBERLY DIANE FREEMAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18144 SECO ST
JAMESTOWN CA
95327-9498
US

IV. Provider business mailing address

PO BOX 4989
SONORA CA
95370-1989
US

V. Phone/Fax

Practice location:
  • Phone: 209-984-4820
  • Fax:
Mailing address:
  • Phone: 209-213-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA81141
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA81141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: