Healthcare Provider Details

I. General information

NPI: 1669742995
Provider Name (Legal Business Name): KIMBERLY JOHANNA LOW VILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MCCONNELL AVE
LOS ANGELES CA
90066-7026
US

IV. Provider business mailing address

POST OFFICE BOX #90486
LOS ANGELES CA
90009
US

V. Phone/Fax

Practice location:
  • Phone: 310-737-4863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2004244
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: