Healthcare Provider Details

I. General information

NPI: 1821914458
Provider Name (Legal Business Name): KIMBERLY CLENDENNING-WOODS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

395 WESTMINISTER DR
SAN JACINTO CA
92583-2691
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 323-920-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number261484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: