Healthcare Provider Details

I. General information

NPI: 1629705249
Provider Name (Legal Business Name): KIMBERLY JUAREZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 REED BLVD STE 120
MILL VALLEY CA
94941-2370
US

IV. Provider business mailing address

23 REED BLVD STE 120
MILL VALLEY CA
94941-2370
US

V. Phone/Fax

Practice location:
  • Phone: 415-795-7000
  • Fax: 415-329-1401
Mailing address:
  • Phone: 415-795-7000
  • Fax: 415-329-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: