Healthcare Provider Details

I. General information

NPI: 1285556381
Provider Name (Legal Business Name): KIMBERLY DAGDAG BABCOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY D BABCOCK RN

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25125 MADISON AVE
MURRIETA CA
92562-8969
US

IV. Provider business mailing address

30512 FRAGRANT ST
MURRIETA CA
92563-0531
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-422-3007
Mailing address:
  • Phone: 909-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95220356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: